Provider Demographics
NPI:1821276577
Name:DAVID J WEISSBERG, MD,PC
Entity Type:Organization
Organization Name:DAVID J WEISSBERG, MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOFREDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-351-0295
Mailing Address - Street 1:379 OAKWOOD RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-7203
Mailing Address - Country:US
Mailing Address - Phone:631-351-0295
Mailing Address - Fax:631-351-0265
Practice Address - Street 1:379 OAKWOOD RD
Practice Address - Street 2:SUITE C
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-7203
Practice Address - Country:US
Practice Address - Phone:631-351-0295
Practice Address - Fax:631-351-0265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2019-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207XX0005X
NY146514332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1720013097Medicaid