Healthcare Provider Details

I. General information

NPI: 1740395854
Provider Name (Legal Business Name): MICHAEL H. WEISSMAN PH.D., M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

2 DEER CREEK LN
MOUNT KISCO NY
10549-3707
US

IV. Provider business mailing address

2 DEER CREEK LN
MOUNT KISCO NY
10549-3707
US

V. Phone/Fax

Practice location:
  • Phone: 914-241-0558
  • Fax:
Mailing address:
  • Phone: 914-241-0558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number131243
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: