Healthcare Provider Details

I. General information

NPI: 1124524319
Provider Name (Legal Business Name): MENACHEM YONAH WEISS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 E MEXICO AVE STE 102
DENVER CO
80210-3941
US

IV. Provider business mailing address

900 NW 17TH ST
MIAMI FL
33136-1119
US

V. Phone/Fax

Practice location:
  • Phone: 720-524-1001
  • Fax: 303-800-2078
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME155316
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberDR.0071480
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: