Healthcare Provider Details

I. General information

NPI: 1053113761
Provider Name (Legal Business Name): BRITTNI L WEISS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 NATHAN HALE DR APT 36A
HUNTINGTON NY
11743-7016
US

IV. Provider business mailing address

25 NATHAN HALE DR APT 36A
HUNTINGTON NY
11743-7016
US

V. Phone/Fax

Practice location:
  • Phone: 561-512-4091
  • Fax:
Mailing address:
  • Phone: 561-512-4091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number827214
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: