Healthcare Provider Details

I. General information

NPI: 1790947190
Provider Name (Legal Business Name): JOSHUA ELLICK WEITZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 07/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WHITE SPRUCE BLVD
ROCHESTER NY
14623-1507
US

IV. Provider business mailing address

100 WHITE SPRUCE BLVD
ROCHESTER NY
14623-1507
US

V. Phone/Fax

Practice location:
  • Phone: 585-272-0700
  • Fax: 585-272-8356
Mailing address:
  • Phone: 585-272-0700
  • Fax: 585-272-8356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number259281
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number259281
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number259281
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: