Provider Demographics
NPI:1871989079
Name:WEISS, ALLEN (DO)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:
Last Name:WEISS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 GRAVESEND NECK RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4428
Mailing Address - Country:US
Mailing Address - Phone:347-978-0122
Mailing Address - Fax:718-336-6319
Practice Address - Street 1:1503 GRAVESEND NECK RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4428
Practice Address - Country:US
Practice Address - Phone:347-978-0122
Practice Address - Fax:718-336-6319
Is Sole Proprietor?:No
Enumeration Date:2015-04-14
Last Update Date:2025-04-15
Deactivation Date:2025-03-30
Deactivation Code:
Reactivation Date:2025-04-15
Provider Licenses
StateLicense IDTaxonomies
NY293992207RC0000X, 208M00000X
NH21053208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05177739Medicaid