Provider Demographics
NPI:1578734984
Name:BRIAN J WEISS
Entity Type:Organization
Organization Name:BRIAN J WEISS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-382-8070
Mailing Address - Street 1:5035 MAYFIELD RD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2688
Mailing Address - Country:US
Mailing Address - Phone:216-382-8070
Mailing Address - Fax:216-382-6767
Practice Address - Street 1:5035 MAYFIELD RD
Practice Address - Street 2:SUITE 215
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-2688
Practice Address - Country:US
Practice Address - Phone:216-382-8070
Practice Address - Fax:216-382-6767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2169332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0678306Medicaid
OH0678306Medicaid
OH0544893Medicare PIN