Healthcare Provider Details

I. General information

NPI: 1093068611
Provider Name (Legal Business Name): STEVEN M. WEISSMAN, MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2012
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9413 FLATLANDS AVE SUITE 102 EAST
BROOKLYN NY
11236-3726
US

IV. Provider business mailing address

4 WESTON PL
LAWRENCE NY
11559-1525
US

V. Phone/Fax

Practice location:
  • Phone: 718-853-7546
  • Fax: 718-682-0146
Mailing address:
  • Phone: 718-853-7546
  • Fax: 718-682-0146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN M WEISSMAN
Title or Position: PROVIDER
Credential: M.D.
Phone: 718-853-7546