Provider Demographics
NPI:1003879990
Name:WEISBERG, JOSEPH (PHD PT)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:WEISBERG
Suffix:
Gender:M
Credentials:PHD PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LARCH DR
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021
Mailing Address - Country:US
Mailing Address - Phone:516-482-8016
Mailing Address - Fax:516-482-8016
Practice Address - Street 1:1 LARCH DR
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021
Practice Address - Country:US
Practice Address - Phone:516-482-8016
Practice Address - Fax:516-482-8016
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0030671225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
A400031OtherOXFORD
A400031OtherOXFORD
Q02762Medicare ID - Type Unspecified