Healthcare Provider Details

I. General information

NPI: 1417949702
Provider Name (Legal Business Name): ROBERT A WEISS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BRADHURST AVE STE. 1400
HAWTHORNE NY
10532-2140
US

IV. Provider business mailing address

157 BRUSH HOLLOW CRES
RYE BROOK NY
10573-1623
US

V. Phone/Fax

Practice location:
  • Phone: 914-493-7583
  • Fax: 914-594-4011
Mailing address:
  • Phone: 914-772-5455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number112832
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: