Healthcare Provider Details

I. General information

NPI: 1215115431
Provider Name (Legal Business Name): ERIC NILES WEISSMAN PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 SCOTCHTOWN AVE
GOSHEN NY
10924
US

IV. Provider business mailing address

PO BOX 582 18 SCOTCHTOWN AVE
GOSHEN NY
10924
US

V. Phone/Fax

Practice location:
  • Phone: 845-800-4172
  • Fax: 845-294-1126
Mailing address:
  • Phone: 845-800-4172
  • Fax: 845-294-1126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number0161291
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: