MEDICARE: WEISSMAN ENDOSCOPY OBS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0800X	Endoscopy Clinic/Center	187803	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205952785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEISSMAN ENDOSCOPY OBS, LLC

Provider Business Mailing Address
First Line	:	27 WHITE DR
Second Line	:
City	:	CEDARHURST
State	:	NY
Zip	:	11516-2607
Country	:	US
Telephone Number	:	718-854-5100
Fax Number	:	718-854-6200

Provider Business Practice Location Address
First Line	:	202 FOSTER AVE
Second Line	:	SUITE C
City	:	BROOKLYN
State	:	NY
Zip	:	11230-2119
Country	:	US
Telephone Number	:	718-854-5100
Fax Number	:	718-854-6200

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. SAM WEISSMAMN
Credential	:	MD
Telephone Number	:	718-854-5100

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	08/22/2020

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