Healthcare Provider Details

I. General information

NPI: 1750950978
Provider Name (Legal Business Name): LAUREN ELENA WEISSBERG BSN, RN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6619 13TH AVE
BROOKLYN NY
11219-6122
US

IV. Provider business mailing address

2892 SHORE RD
SEAFORD NY
11783-3334
US

V. Phone/Fax

Practice location:
  • Phone: 347-970-9164
  • Fax:
Mailing address:
  • Phone: 516-860-3274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number746708-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: