MEDICARE: NEAL WEISBROD

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	2084N0400X	Neurology Physician	80116	CT

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	:	1407199748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEAL WEISBROD

Provider Business Mailing Address
First Line	:	1290 SILAS DEANE HIGHWAY
Second Line	:	HHC - CVO
City	:	WETHERSFIELD
State	:	CT
Zip	:	06109
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 PERKINS FARM DR STE 303
Second Line	:
City	:	MYSTIC
State	:	CT
Zip	:	06355-4041
Country	:	US
Telephone Number	:	860-886-1433
Fax Number	:

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

Provider Enumeration Date	:	04/05/2013
Last Update Date	:	02/13/2025

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Directions to “ NEAL WEISBROD ” Practice Location

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