Healthcare Provider Details

I. General information

NPI: 1083683163
Provider Name (Legal Business Name): MOSHE WEISS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 OLD NYACK TURNPIKE
SPRING VALLEY NY
10977
US

IV. Provider business mailing address

12 GALILEO COURT
SUFFERN NY
10901
US

V. Phone/Fax

Practice location:
  • Phone: 845-371-8777
  • Fax: 845-371-7809
Mailing address:
  • Phone: 845-406-4608
  • Fax: 845-371-7809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number219714
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: