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NPI Code Detail

MEDICARE: MR. CRAIG ALAN WEISE MS, ANP

MEDICARE: MR. CRAIG ALAN WEISE MS, ANP
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
1363LA2200XAdult Health Nurse PractitionerF-304637NY

General Provider Information

NPI Number : 1215133509
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CRAIG ALAN WEISE MS, ANP
Provider Business Mailing Address
First Line : 1304 DRIVING PARK AVE
Second Line :
City : NEWARK
State : NY
Zip : 14513-1059
Country : US
Telephone Number : 315-395-2213
Fax Number : 315-359-2139
Provider Business Practice Location Address
First Line : 1304 DRIVING PARK AVE
Second Line :
City : NEWARK
State : NY
Zip : 14513-1059
Country : US
Telephone Number : 315-359-2133
Fax Number : 315-359-2139
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2007
Last Update Date : 05/06/2021

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