MEDICARE: DR. STEVEN M WEISSMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	211457	NY

General Provider Information

NPI Number	:	1164408282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN M WEISSMAN MD

Provider Business Mailing Address
First Line	:	57 MURIEL AVE
Second Line	:
City	:	LAWRENCE
State	:	NY
Zip	:	11559-1810
Country	:	US
Telephone Number	:	718-853-7546
Fax Number	:	718-682-0146

Provider Business Practice Location Address
First Line	:	9413 FLATLANDS AVE
Second Line	:	STE 102 EAST
City	:	BROOKLYN
State	:	NY
Zip	:	11236-3726
Country	:	US
Telephone Number	:	718-853-7546
Fax Number	:	718-682-0146

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	12/20/2021

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