Provider Demographics
NPI:1245201078
Name:WEISS, MICHAEL J
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:WEISS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 W 165TH ST STE 374
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3724
Mailing Address - Country:US
Mailing Address - Phone:212-305-9925
Mailing Address - Fax:212-305-8514
Practice Address - Street 1:635 WEST 165TH ST SUITE 101
Practice Address - Street 2:HARKNESS EYE INSTITUTE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:212-305-9925
Practice Address - Fax:212-305-8514
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152454207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY42D051Medicare PIN
NYB80593Medicare UPIN