Provider Demographics
NPI:1962716019
Name:WEISBROT, ERIC ANDREW (LAC)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:ANDREW
Last Name:WEISBROT
Suffix:
Gender:M
Credentials:LAC
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 40214
Mailing Address - Street 2:
Mailing Address - City:GLEN OAKS
Mailing Address - State:NY
Mailing Address - Zip Code:11004-0214
Mailing Address - Country:US
Mailing Address - Phone:201-232-2933
Mailing Address - Fax:
Practice Address - Street 1:3 DELAWARE DR
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1116
Practice Address - Country:US
Practice Address - Phone:201-232-2933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-31
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25003852171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist