MEDICARE: DR. EDWARD MARTIN WEILAND 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	2084N0400X	Neurology Physician	158445-1	NY

General Provider Information

NPI Number	:	1891819751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD MARTIN WEILAND M.D.

Provider Business Mailing Address
First Line	:	134 SHOREWARD DR
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11021-2514
Country	:	US
Telephone Number	:	516-482-0420
Fax Number	:

Provider Business Practice Location Address
First Line	:	4015 AVENUE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5117
Country	:	US
Telephone Number	:	718-338-5686
Fax Number	:

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

Provider Enumeration Date	:	03/18/2007
Last Update Date	:	07/08/2007

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