Provider Demographics
NPI:1619110434
Name:WEBER, GEORGE (RN)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:
Last Name:WEBER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:638 FRESH POND AVE UNIT 351
Mailing Address - Street 2:
Mailing Address - City:CALVERTON
Mailing Address - State:NY
Mailing Address - Zip Code:11933-1191
Mailing Address - Country:US
Mailing Address - Phone:631-565-2961
Mailing Address - Fax:
Practice Address - Street 1:638 FRESH POND AVE UNIT 351
Practice Address - Street 2:
Practice Address - City:CALVERTON
Practice Address - State:NY
Practice Address - Zip Code:11933-1191
Practice Address - Country:US
Practice Address - Phone:631-565-2961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY599865-1163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice