Provider Demographics
NPI:1386625168
Name:WEBER, MARC (MD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:WEBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W BROADWAY
Mailing Address - Street 2:SUITE 7
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1913
Mailing Address - Country:US
Mailing Address - Phone:516-374-5024
Mailing Address - Fax:516-374-5816
Practice Address - Street 1:1200 W BROADWAY
Practice Address - Street 2:SUITE 7
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-1913
Practice Address - Country:US
Practice Address - Phone:516-374-5024
Practice Address - Fax:516-374-5816
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201723208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01786263Medicaid
NY01786263Medicaid
NY17X321Medicare ID - Type Unspecified