Provider Demographics
NPI:1760456396
Name:WEISS, WAYNE MARK (MD)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:MARK
Last Name:WEISS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:384 CRYSTAL RUN RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-4013
Mailing Address - Country:US
Mailing Address - Phone:845-692-8780
Mailing Address - Fax:845-692-3439
Practice Address - Street 1:384 CRYSTAL RUN RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-4013
Practice Address - Country:US
Practice Address - Phone:845-692-8780
Practice Address - Fax:845-692-3439
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2012-02-01
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Provider Licenses
StateLicense IDTaxonomies
NY1705792086S0102X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02010713Medicaid
NYF90746Medicare UPIN