Provider Demographics
NPI:1427070762
Name:WEISS, RICHARD A (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:WEISS
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 1:556 N COUNTRY RD STE 6
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-1422
Mailing Address - Country:US
Mailing Address - Phone:631-686-6502
Mailing Address - Fax:
Practice Address - Street 1:556 N COUNTRY RD STE 6
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-1422
Practice Address - Country:US
Practice Address - Phone:631-686-6502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY180728-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY54K261OtherEMPIRE BC/BS
NY54K261OtherEMPIRE BC/BS
NY54K2685961Medicare PIN
NYE97056Medicare UPIN