Provider Demographics
NPI:1710250659
Name:SCOTT S WEISSMAN, MD PC
Entity Type:Organization
Organization Name:SCOTT S WEISSMAN, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:S
Authorized Official - Last Name:WEISSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-750-2444
Mailing Address - Street 1:340 E 49TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-1697
Mailing Address - Country:US
Mailing Address - Phone:212-750-2444
Mailing Address - Fax:212-750-8430
Practice Address - Street 1:340 E 49TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-1697
Practice Address - Country:US
Practice Address - Phone:212-750-2444
Practice Address - Fax:212-750-8430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY165534207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02995OtherGHI MEDICARE PTAN
NY01133357Medicaid
NY01133357Medicaid