Provider Demographics
NPI:1841647419
Name:WEISSBROD, HEATH
Entity type:Individual
Prefix:
First Name:HEATH
Middle Name:
Last Name:WEISSBROD
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 1:1530 NE 191ST ST APT 225
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4155
Mailing Address - Country:US
Mailing Address - Phone:305-282-0333
Mailing Address - Fax:
Practice Address - Street 1:50 COURT ST STE 1002
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4821
Practice Address - Country:US
Practice Address - Phone:212-695-5122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018914-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant