Provider Demographics
NPI:1639371586
Name:HAROLD WEISSMAN MD PC
Entity Type:Organization
Organization Name:HAROLD WEISSMAN MD PC
Other - Org Name:REGO PARK MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEISSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-592-3200
Mailing Address - Street 1:5910 JUNCTION BLVD
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5156
Mailing Address - Country:US
Mailing Address - Phone:718-592-3200
Mailing Address - Fax:718-592-3844
Practice Address - Street 1:5910 JUNCTION BLVD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5156
Practice Address - Country:US
Practice Address - Phone:718-592-3200
Practice Address - Fax:718-592-3844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169881261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00574167Medicaid
NY00574167Medicaid
NY25537Medicare ID - Type Unspecified