Provider Demographics
NPI:1811068364
Name:WEISS, MATTHEW BRIAN (DC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:BRIAN
Last Name:WEISS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 PONY CIR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-1980
Mailing Address - Country:US
Mailing Address - Phone:718-575-0300
Mailing Address - Fax:
Practice Address - Street 1:6915 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4238
Practice Address - Country:US
Practice Address - Phone:718-575-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007748111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor