Provider Demographics
NPI:1265410963
Name:WEISS, GLENN B (DPM)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:B
Last Name:WEISS
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:57 WEST 57TH STREET
Mailing Address - Street 2:STE 1201
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1423
Mailing Address - Country:US
Mailing Address - Phone:716-456-8027
Mailing Address - Fax:212-755-3676
Practice Address - Street 1:57 WEST 57TH STREET
Practice Address - Street 2:STE 1201
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1423
Practice Address - Country:US
Practice Address - Phone:716-456-8027
Practice Address - Fax:212-755-3676
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2023-04-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYN003145-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP34191Medicare PIN
NY4814190001Medicare NSC
NYT32007Medicare UPIN