MEDICARE: DR. GLENN B WEISS D.P.M.

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	213E00000X	Podiatrist	N003145-1	NY

General Provider Information

NPI Number	:	1265410963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLENN B WEISS D.P.M.

Provider Business Mailing Address
First Line	:	57 WEST 57TH STREET
Second Line	:	STE 1201
City	:	NEW YORK
State	:	NY
Zip	:	10019-1423
Country	:	US
Telephone Number	:	716-456-8027
Fax Number	:	212-755-3676

Provider Business Practice Location Address
First Line	:	57 WEST 57TH STREET
Second Line	:	STE 1201
City	:	NEW YORK
State	:	NY
Zip	:	10019-1423
Country	:	US
Telephone Number	:	716-456-8027
Fax Number	:	212-755-3676

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

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	04/07/2023

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