Healthcare Provider Details

I. General information

NPI: 1245356468
Provider Name (Legal Business Name): JUSTIN M WEIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 PARRISH ST
CANANDAIGUA NY
14424-1731
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 692
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-396-6636
  • Fax: 585-396-6492
Mailing address:
  • Phone: 585-275-4161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number254935
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number254935
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: