Healthcare Provider Details

I. General information

NPI: 1184724213
Provider Name (Legal Business Name): ZVI SAMUEL WEISSTUCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 03/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUSTAVE L LEVY PL # 1230
NEW YORK NY
10029-6500
US

IV. Provider business mailing address

PO BOX 1230
NEW YORK NY
10029-0313
US

V. Phone/Fax

Practice location:
  • Phone: 212-659-8806
  • Fax:
Mailing address:
  • Phone: 212-659-8806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number222074-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: