Basic Information
| Provider Information | |||||||||
| NPI: | 1730601881 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEAVER | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | PATRICK | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | NPP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7844 226TH ST | ||||||||
| Address2: | |||||||||
| City: | OAKLAND GARDENS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113643625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6467523552 | ||||||||
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| Practice Location | |||||||||
| Address1: | 222 STATION PLZ N STE 350A | ||||||||
| Address2: | |||||||||
| City: | MINEOLA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115013814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166632691 | ||||||||
| FaxNumber: | 5166638971 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2017 | ||||||||
| LastUpdateDate: | 04/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 402169 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.