Provider Demographics
NPI:1811381551
Name:WEILER, JOSHUA ADAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:ADAM
Last Name:WEILER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 PARK LN
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-2713
Mailing Address - Country:US
Mailing Address - Phone:516-316-4624
Mailing Address - Fax:
Practice Address - Street 1:1601 VETERANS MEMORIAL HWY
Practice Address - Street 2:#200
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-1538
Practice Address - Country:US
Practice Address - Phone:931-348-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-19
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY726998992390200000X
NY058793122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program