MEDICARE: DR. JOSHUA ELLICK WEITZ M.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	207R00000X	Internal Medicine Physician	259281	NY
2	207K00000X	Allergy & Immunology Physician	259281	NY
3	207RR0500X	Rheumatology Physician	259281	NY

General Provider Information

NPI Number	:	1790947190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSHUA ELLICK WEITZ M.D.

Provider Business Mailing Address
First Line	:	100 WHITE SPRUCE BLVD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14623-1507
Country	:	US
Telephone Number	:	585-272-0700
Fax Number	:	585-272-8356

Provider Business Practice Location Address
First Line	:	100 WHITE SPRUCE BLVD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14623-1507
Country	:	US
Telephone Number	:	585-272-0700
Fax Number	:	585-272-8356

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

Provider Enumeration Date	:	06/26/2008
Last Update Date	:	07/21/2014

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