Provider Demographics
NPI:1962430488
Name:WEISS, ANTHONY A (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
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 1:620 COLUMBUS AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1458
Mailing Address - Country:US
Mailing Address - Phone:212-721-2600
Mailing Address - Fax:212-721-6230
Practice Address - Street 1:620 COLUMBUS AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-1458
Practice Address - Country:US
Practice Address - Phone:212-721-2600
Practice Address - Fax:212-721-6230
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY178909207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY112990594OtherGROUP TAX ID
NY01601183Medicaid
NY01601183Medicaid
NY29K771Medicare PIN
NYF21254Medicare UPIN