MEDICARE: DR. MARC WEBER M.D.

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	208100000X	Physical Medicine & Rehabilitation Physician	201723	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	:	1386625168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC WEBER M.D.

Provider Business Mailing Address
First Line	:	1200 W BROADWAY
Second Line	:	SUITE 7
City	:	HEWLETT
State	:	NY
Zip	:	11557-1913
Country	:	US
Telephone Number	:	516-374-5024
Fax Number	:	516-374-5816

Provider Business Practice Location Address
First Line	:	1200 W BROADWAY
Second Line	:	SUITE 7
City	:	HEWLETT
State	:	NY
Zip	:	11557-1913
Country	:	US
Telephone Number	:	516-374-5024
Fax Number	:	516-374-5816

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

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	07/08/2007

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