MEDICARE: LAWRENCE J WEISS DDS PC

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	261QD0000X	Dental Clinic/Center	043555	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194709410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAWRENCE J WEISS DDS PC

Provider Business Mailing Address
First Line	:	3131 LAWSON BLVD
Second Line	:
City	:	OCEANSIDE
State	:	NY
Zip	:	11572-3717
Country	:	US
Telephone Number	:	516-764-3062
Fax Number	:	516-764-0266

Provider Business Practice Location Address
First Line	:	3131 LAWSON BLVD
Second Line	:
City	:	OCEANSIDE
State	:	NY
Zip	:	11572-3717
Country	:	US
Telephone Number	:	516-764-3062
Fax Number	:	516-764-0266

Authorized Official
Title or Position	:	DENTIST OWNER
Name	:	DR. LAWRENCE J WEISS
Credential	:	DDS
Telephone Number	:	516-764-3062

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	08/22/2020

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