Provider Demographics
NPI:1205952785
Name:WEISSMAN ENDOSCOPY OBS, LLC
Entity type:Organization
Organization Name:WEISSMAN ENDOSCOPY OBS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISSMAMN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-854-5100
Mailing Address - Street 1:27 WHITE DR
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-2607
Mailing Address - Country:US
Mailing Address - Phone:718-854-5100
Mailing Address - Fax:718-854-6200
Practice Address - Street 1:202 FOSTER AVE
Practice Address - Street 2:SUITE C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-2119
Practice Address - Country:US
Practice Address - Phone:718-854-5100
Practice Address - Fax:718-854-6200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187803261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01659961Medicaid
NY07N932Medicare ID - Type Unspecified
NY01659961Medicaid