Provider Demographics
NPI:1598010274
Name:DAVID J WEISSBERG, MD, PC
Entity Type:Organization
Organization Name:DAVID J WEISSBERG, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEISSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-351-0295
Mailing Address - Street 1:379 OAKWOOD RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-7203
Mailing Address - Country:US
Mailing Address - Phone:631-482-9192
Mailing Address - Fax:
Practice Address - Street 1:400 MONTAUK HWY
Practice Address - Street 2:SUITE 108
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4429
Practice Address - Country:US
Practice Address - Phone:631-482-9192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2019-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146514332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5586430001Medicare NSC