Provider Demographics
NPI:1891819751
Name:WEILAND, EDWARD MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:MARTIN
Last Name:WEILAND
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 1:134 SHOREWARD DR
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2514
Mailing Address - Country:US
Mailing Address - Phone:516-482-0420
Mailing Address - Fax:
Practice Address - Street 1:4015 AVENUE U
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5117
Practice Address - Country:US
Practice Address - Phone:718-338-5686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY158445-12084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB-17757Medicare UPIN