MEDICARE: DR. STUART P WEISBERG M.D/ PHD

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	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician	251752	NY

General Provider Information

NPI Number	:	1417391038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STUART P WEISBERG M.D/ PHD

Provider Business Mailing Address
First Line	:	8 COLONEL ROBERT MAGAW PL
Second Line	:	APT 21B
City	:	NEW YORK
State	:	NY
Zip	:	10033-5222
Country	:	US
Telephone Number	:	917-541-4085
Fax Number	:

Provider Business Practice Location Address
First Line	:	622 W 168TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-3720
Country	:	US
Telephone Number	:	917-541-4085
Fax Number	:

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

Provider Enumeration Date	:	04/25/2013
Last Update Date	:	02/01/2019

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