Provider Demographics
NPI:1710040688
Name:WEISE, EUGENE EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:EDWARD
Last Name:WEISE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 EAST 61 STREET
Mailing Address - Street 2:7C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:212-628-0800
Mailing Address - Fax:212-935-1999
Practice Address - Street 1:115 EAST 61 STREET
Practice Address - Street 2:7C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-628-0800
Practice Address - Fax:212-935-1999
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYMD097307207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00163786Medicaid
NY00163786Medicaid
C11835Medicare UPIN