1497962740 NPI number — MR. IRA SCOTT WEISS C.A.S.A.C.

Table of content: MR. IRA SCOTT WEISS C.A.S.A.C. (NPI 1497962740)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497962740 NPI number — MR. IRA SCOTT WEISS C.A.S.A.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEISS
Provider First Name:
IRA
Provider Middle Name:
SCOTT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
C.A.S.A.C.
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:
1497962740
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2989 N JERUSALEM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEVITTOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11756-3510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-336-2643
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
246 CENTRAL PARK AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARTSDALE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-949-6640
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/17/2007

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: 101YA0400X , with the licence number:  9763 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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