Healthcare Provider Details

I. General information

NPI: 1164586442
Provider Name (Legal Business Name): HERMAN WEISS M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 N BROADWAY
MASSAPEQUA NY
11758-2355
US

IV. Provider business mailing address

331 MAPLE ST
WEST HEMPSTEAD NY
11552-3252
US

V. Phone/Fax

Practice location:
  • Phone: 516-795-2890
  • Fax: 516-795-7450
Mailing address:
  • Phone: 516-505-0444
  • Fax: 516-485-9589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number215938
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: