Provider Demographics
NPI:1053350579
Name:WEISSMAN, MATTHEW ARON (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ARON
Last Name:WEISSMAN
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 1:60 MADISON AVE
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-1600
Mailing Address - Country:US
Mailing Address - Phone:212-545-2439
Mailing Address - Fax:646-312-0481
Practice Address - Street 1:10 UNION SQ E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3314
Practice Address - Country:US
Practice Address - Phone:212-844-8100
Practice Address - Fax:212-844-8154
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225158208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NY02682084Medicaid
NY331945Medicare Oscar/Certification
NY1540S1Medicare ID - Type Unspecified
NY331946Medicare Oscar/Certification
NY331058Medicare Oscar/Certification
NY331947Medicare Oscar/Certification
NYW6L111Medicare Oscar/Certification
NY331009Medicare Oscar/Certification
NY331043Medicare Oscar/Certification
NY00695941Medicaid
NY331944Medicare Oscar/Certification
NY331952Medicare Oscar/Certification
NYI43180Medicare UPIN
NY02682084Medicaid
NY331954Medicare Oscar/Certification