Healthcare Provider Details

I. General information

NPI: 1528658564
Provider Name (Legal Business Name): STEVEN WILLIAM WEAVER JR. PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2021
Last Update Date: 01/23/2021
Certification Date: 01/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 ALTAMONT AVE
SCHENECTADY NY
12303-2909
US

IV. Provider business mailing address

16 1ST ST
COHOES NY
12047-3639
US

V. Phone/Fax

Practice location:
  • Phone: 518-264-9000
  • Fax:
Mailing address:
  • Phone: 518-928-6357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number026072
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: