Provider Demographics
NPI:1699785386
Name:WEILER, MARC EDMUND (PHD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:EDMUND
Last Name:WEILER
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 783
Mailing Address - Street 2:
Mailing Address - City:CROSS RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10518
Mailing Address - Country:US
Mailing Address - Phone:914-763-3244
Mailing Address - Fax:914-763-1126
Practice Address - Street 1:19 MARK MEAD ROAD
Practice Address - Street 2:
Practice Address - City:CROSS RIVER
Practice Address - State:NY
Practice Address - Zip Code:10518
Practice Address - Country:US
Practice Address - Phone:914-763-3244
Practice Address - Fax:914-763-1126
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2025-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0076721103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00836659Medicaid
NY00836659Medicaid
R15833Medicare UPIN