Individual
MATTHEW J WEISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1111 MARCUS AVE, NEW HYDE PARK, NY 11042
(516) 321-2239
Mailing address
PO BOX 64563, BALTIMORE, MD 21264-4563
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
224660
MA
2086X0206X
Surgical Oncology Physician
Primary
256179
NY
2086X0206X
Surgical Oncology Physician
D73814
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
055404900
—
MD
05
—
2114003
—
MA
01
—
J29775
BLUE SHIELD
MA
Enumeration date
05/22/2006
Last updated
02/27/2019
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