Provider Demographics
NPI:1780755975
Name:WEISS, ELISE (MD)
Entity type:Individual
Prefix:DR
First Name:ELISE
Middle Name:
Last Name:WEISS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 MADISON AVE
Mailing Address - Street 2:SUITE 1906
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-5403
Mailing Address - Country:US
Mailing Address - Phone:212-752-6770
Mailing Address - Fax:212-754-0369
Practice Address - Street 1:515 MADISON AVE
Practice Address - Street 2:SUITE 1906
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-5403
Practice Address - Country:US
Practice Address - Phone:212-752-6770
Practice Address - Fax:212-754-0369
Is Sole Proprietor?:No
Enumeration Date:2006-11-11
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236095208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY051G31L061Medicare PIN