MEDICARE: MR. ERIC ANDREW WEISBROT LAC

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	171100000X	Acupuncturist	25003852	NY
2	225700000X	Massage Therapist	017009	NY

General Provider Information

NPI Number	:	1962716019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ERIC ANDREW WEISBROT LAC

Provider Business Mailing Address
First Line	:	PO BOX 40214
Second Line	:
City	:	GLEN OAKS
State	:	NY
Zip	:	11004-0214
Country	:	US
Telephone Number	:	201-232-2933
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 DELAWARE DR
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1116
Country	:	US
Telephone Number	:	201-232-2933
Fax Number	:

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

Provider Enumeration Date	:	07/31/2010
Last Update Date	:	01/31/2026

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