Provider Demographics
NPI:1689712614
Name:WEISER, GAIL SUSAN (PA-C, LCSW)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:SUSAN
Last Name:WEISER
Suffix:
Gender:F
Credentials:PA-C, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 SHEPARD ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-1818
Mailing Address - Country:US
Mailing Address - Phone:585-739-2276
Mailing Address - Fax:
Practice Address - Street 1:39 N GOODMAN ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-1578
Practice Address - Country:US
Practice Address - Phone:585-271-2937
Practice Address - Fax:585-271-3575
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0693381041C0700X
PAMA-000169-L363AM0700X
NY002458-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY110134BFOtherPREFERRED CARE
NY7884309OtherAETNA
NY7884309OtherAETNA
NY110134BFOtherPREFERRED CARE