Provider Demographics
NPI:1104900414
Name:WEITZMAN, STUART CRAIG (DC)
Entity type:Individual
Prefix:
First Name:STUART
Middle Name:CRAIG
Last Name:WEITZMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10507-1819
Mailing Address - Country:US
Mailing Address - Phone:914-242-8810
Mailing Address - Fax:914-241-8719
Practice Address - Street 1:85 ADAMS ST
Practice Address - Street 2:
Practice Address - City:BEDFORD HILLS
Practice Address - State:NY
Practice Address - Zip Code:10507-1819
Practice Address - Country:US
Practice Address - Phone:914-242-8810
Practice Address - Fax:914-241-8719
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9291NY111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
X1C531Medicare UPIN
XAWHM1Medicare ID - Type Unspecified