Provider Demographics
NPI:1598702623
Name:WEISEN, STEVEN FRED (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:FRED
Last Name:WEISEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 INDIAN ROCK
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-4907
Mailing Address - Country:US
Mailing Address - Phone:845-368-0100
Mailing Address - Fax:845-368-3866
Practice Address - Street 1:26 INDIAN ROCK
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4907
Practice Address - Country:US
Practice Address - Phone:845-368-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209271207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH85434Medicare UPIN
NJ070112BSDMedicare ID - Type Unspecified