1376720169 NPI number — DR. SCOTT H WEISS DPM

Table of content: DR. SCOTT H WEISS DPM (NPI 1376720169)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376720169 NPI number — DR. SCOTT H WEISS DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEISS
Provider First Name:
SCOTT
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376720169
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 POST RD
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
DARIEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06820-4622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-656-1696
Provider Business Mailing Address Fax Number:
203-656-1742

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 POST RD
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
DARIEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06820-4622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-656-1696
Provider Business Practice Location Address Fax Number:
203-656-1742
Provider Enumeration Date:
01/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  000827 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000827 . This is a "CT LICENSC" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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