Provider Demographics
NPI:1720013097
Name:WEISSBERG, DAVID JAY (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JAY
Last Name:WEISSBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:800 WOODBURY RD STE 100G
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2503
Mailing Address - Country:US
Mailing Address - Phone:631-351-0295
Mailing Address - Fax:631-351-0265
Practice Address - Street 1:800 WOODBURY RD STE 100G
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2503
Practice Address - Country:US
Practice Address - Phone:631-351-0295
Practice Address - Fax:631-351-0265
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY146514207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100040911Medicare PIN