MEDICARE: MARTIN WEISS MSED, BCBA LP

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	103K00000X	Behavior Analyst	BACB351913	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	:	1891280285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTIN WEISS MSED, BCBA LP

Provider Business Mailing Address
First Line	:	1426 46TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-2632
Country	:	US
Telephone Number	:	347-988-5772
Fax Number	:

Provider Business Practice Location Address
First Line	:	4404 14TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-2104
Country	:	US
Telephone Number	:	347-988-5772
Fax Number	:

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

Provider Enumeration Date	:	06/27/2018
Last Update Date	:	06/27/2018

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