Provider Demographics
NPI:1356373013
Name:WEISSMAN, LAURENCE R (MD)
Entity type:Individual
Prefix:
First Name:LAURENCE
Middle Name:R
Last Name:WEISSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16110 UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1934
Mailing Address - Country:US
Mailing Address - Phone:718-380-8050
Mailing Address - Fax:718-380-5303
Practice Address - Street 1:16110 UNION TPKE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11366-1934
Practice Address - Country:US
Practice Address - Phone:718-380-8050
Practice Address - Fax:718-380-5303
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146649207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00845565Medicaid
NY00097HMedicare ID - Type Unspecified
NY00845565Medicaid
NY26D471Medicare PIN
A61656Medicare UPIN