Healthcare Provider Details

I. General information

NPI: 1689712614
Provider Name (Legal Business Name): GAIL SUSAN WEISER PA-C, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 N GOODMAN ST
ROCHESTER NY
14607-1578
US

IV. Provider business mailing address

160 SHEPARD ST
ROCHESTER NY
14620-1818
US

V. Phone/Fax

Practice location:
  • Phone: 585-271-2937
  • Fax: 585-271-3575
Mailing address:
  • Phone: 585-739-2276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA-000169-L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number002458-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number069338
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: