Provider Demographics
NPI:1194748822
Name:WEISS, PHILIP M (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:M
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:279 MAIN ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-1623
Mailing Address - Country:US
Mailing Address - Phone:845-255-3046
Mailing Address - Fax:845-255-0236
Practice Address - Street 1:1 FAMILY PRACTICE DR
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-6449
Practice Address - Country:US
Practice Address - Phone:845-331-6356
Practice Address - Fax:845-331-6356
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2014-10-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY149300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01069516Medicaid
NY149300OtherLICENSE
NY58F201Medicare ID - Type UnspecifiedMEDICARE
NY149300OtherLICENSE
NYA400024215Medicare Oscar/Certification