Provider Demographics
NPI:1134171481
Name:WEISS, STEPHEN R (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:R
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 W 57TH ST
Mailing Address - Street 2:SUITE 503
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3300
Mailing Address - Country:US
Mailing Address - Phone:212-765-0765
Mailing Address - Fax:646-285-0435
Practice Address - Street 1:142 W 57TH ST
Practice Address - Street 2:SUITE 503
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3300
Practice Address - Country:US
Practice Address - Phone:212-765-0765
Practice Address - Fax:646-285-0435
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY197510207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY197510OtherNY LICENSE
G86325Medicare UPIN
WEV041Medicare ID - Type Unspecified