Provider Demographics
NPI:1619038866
Name:WEBER, NIVA (MD)
Entity Type:Individual
Prefix:
First Name:NIVA
Middle Name:
Last Name:WEBER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:EASTCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10709-3845
Mailing Address - Country:US
Mailing Address - Phone:914-779-6710
Mailing Address - Fax:914-779-2586
Practice Address - Street 1:183 BEECH ST
Practice Address - Street 2:
Practice Address - City:EASTCHESTER
Practice Address - State:NY
Practice Address - Zip Code:10709-3845
Practice Address - Country:US
Practice Address - Phone:914-779-6710
Practice Address - Fax:914-779-2586
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY119620207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00667592Medicaid
NYWP209OtherOXFORD
NY00667592Medicaid
NY10A131Medicare ID - Type Unspecified