Provider Demographics
NPI:1912083064
Name:WEISS, SUSAN C (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:C
Last Name:WEISS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 E 42ND ST
Mailing Address - Street 2:SUITE 1308
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-5405
Mailing Address - Country:US
Mailing Address - Phone:212-490-9328
Mailing Address - Fax:
Practice Address - Street 1:50 E 42ND ST
Practice Address - Street 2:SUITE 1308
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-5405
Practice Address - Country:US
Practice Address - Phone:212-490-9328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0382571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice