MEDICARE: DR. SUSAN C WEISS D.D.S.

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	1223G0001X	General Practice Dentistry	038257	NY

General Provider Information

NPI Number	:	1912083064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN C WEISS D.D.S.

Provider Business Mailing Address
First Line	:	50 E 42ND ST
Second Line	:	SUITE 1308
City	:	NEW YORK
State	:	NY
Zip	:	10017-5405
Country	:	US
Telephone Number	:	212-490-9328
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 E 42ND ST
Second Line	:	SUITE 1308
City	:	NEW YORK
State	:	NY
Zip	:	10017-5405
Country	:	US
Telephone Number	:	212-490-9328
Fax Number	:

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

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	07/08/2007

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