Provider Demographics
NPI:1619912748
Name:WEISS, DON (MD MPH)
Entity Type:Individual
Prefix:DR
First Name:DON
Middle Name:
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4209 28TH ST FL 6
Mailing Address - Street 2:GOTHAM CENTER, CN# 22A
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-4130
Mailing Address - Country:US
Mailing Address - Phone:347-396-2626
Mailing Address - Fax:347-396-2753
Practice Address - Street 1:4209 28TH ST FL 6
Practice Address - Street 2:GOTHAM CENTER, CN# 22A
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-4130
Practice Address - Country:US
Practice Address - Phone:347-396-2626
Practice Address - Fax:347-396-2753
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173221208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1619912748OtherNPI
F60876Medicare UPIN
NY735111Medicare ID - Type UnspecifiedEMPIRE