Provider Demographics
NPI:1932320637
Name:WEBER, JOHN (RPA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:WEBER
Suffix:
Gender:M
Credentials:RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:317 E 17TH ST
Mailing Address - Street 2:KRUEGER CLINIC
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3804
Mailing Address - Country:US
Mailing Address - Phone:212-420-2805
Mailing Address - Fax:212-420-3804
Practice Address - Street 1:317 E 17TH ST
Practice Address - Street 2:KRUEGER CLINIC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3804
Practice Address - Country:US
Practice Address - Phone:212-420-2805
Practice Address - Fax:212-420-3804
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY000511363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02840339Medicaid