MEDICARE: DR. SARA L WEISS ED,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	103TF0200X	Forensic Psychologist	006509	NY

General Provider Information

NPI Number	:	1518271865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARA L WEISS ED,D

Provider Business Mailing Address
First Line	:	251 RICHMOND HILL RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-5906
Country	:	US
Telephone Number	:	718-494-9397
Fax Number	:	718-761-1000

Provider Business Practice Location Address
First Line	:	251 RICHMOND HILL RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-5906
Country	:	US
Telephone Number	:	718-494-9397
Fax Number	:	718-761-1000

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

Provider Enumeration Date	:	07/28/2010
Last Update Date	:	07/28/2010

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