Provider Demographics
NPI:1255393708
Name:WEISS, STEVEN DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:DANIEL
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 1:24 CARROW ST
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2604
Mailing Address - Country:US
Mailing Address - Phone:716-662-3443
Mailing Address - Fax:716-972-0374
Practice Address - Street 1:24 CARROW ST
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-2604
Practice Address - Country:US
Practice Address - Phone:716-662-3443
Practice Address - Fax:716-972-0374
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1412842080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01044673Medicaid
NY00010187102OtherUNIVERA HEALTHCARE
NY000511214004OtherBLUE CROSS/BLUE SHIELD (HEALTH NOW)
NY1205479OtherINDEPENDENT HEALTH ASSOCIATION