Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 011167 | NY |
N | 103T00000X | Psychologist | 011167 | NY |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 011167 | NY |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 011167 | NY |
NPI | 1225196892 |
---|---|
Provider Name | Dr. Gaston Weisz |
First Address | Plainview, NY 11803-1943 |
Second Address | Lynbrook, NY 11563-3027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 08/07/2007 |