Provider Demographics
NPI:1306946991
Name:WEBER, JOHN JOSEPH JR (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:WEBER
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1684 WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-2667
Mailing Address - Country:US
Mailing Address - Phone:516-379-8935
Mailing Address - Fax:516-379-0132
Practice Address - Street 1:70 GLEN ST
Practice Address - Street 2:SUITE 380
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2855
Practice Address - Country:US
Practice Address - Phone:516-759-2424
Practice Address - Fax:516-759-6627
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYNYS 4438213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP45913OtherBLUE CROSS/BLUE SHIELD
NY17898OtherGROUP HEALTH INC.
NY01082526Medicaid
NYP45911OtherBLUE CROSS/BLUE SHIELD
NYP45912OtherBLUE CROSS/BLUE SHIELD
NYP45911OtherBLUE CROSS/BLUE SHIELD
NYP45912OtherBLUE CROSS/BLUE SHIELD
NYP45911Medicare ID - Type UnspecifiedBLUE CROSS BLUE SHIELD
NY17898AMedicare ID - Type UnspecifiedGHI MEDICARE