MEDICARE: DR. GASTON WEISZ PSY.D.

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	103TB0200X	Cognitive & Behavioral Psychologist	011167	NY
2	103TC2200X	Clinical Child & Adolescent Psychologist	011167	NY
3	103T00000X	Psychologist	011167	NY

General Provider Information

NPI Number	:	1225196892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GASTON WEISZ PSY.D.

Provider Business Mailing Address
First Line	:	65 MARILYN BLVD
Second Line	:
City	:	PLAINVIEW
State	:	NY
Zip	:	11803-1943
Country	:	US
Telephone Number	:	516-822-0955
Fax Number	:	516-872-8664

Provider Business Practice Location Address
First Line	:	620 8TH AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10018-1618
Country	:	US
Telephone Number	:	516-822-0955
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	01/26/2026

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