MEDICARE: DR. DON WEISS MD MPH

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	208000000X	Pediatrics Physician	173221	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1619912748	OTHER		NPI

General Provider Information

NPI Number	:	1619912748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DON WEISS MD MPH

Provider Business Mailing Address
First Line	:	4209 28TH ST FL 6
Second Line	:	GOTHAM CENTER, CN# 22A
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-4130
Country	:	US
Telephone Number	:	347-396-2626
Fax Number	:	347-396-2753

Provider Business Practice Location Address
First Line	:	4209 28TH ST FL 6
Second Line	:	GOTHAM CENTER, CN# 22A
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-4130
Country	:	US
Telephone Number	:	347-396-2626
Fax Number	:	347-396-2753

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

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	03/12/2013

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