Basic Information
| Provider Information | |||||||||
| NPI: | 1841647419 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEISSBROD | ||||||||
| FirstName: | HEATH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1530 NE 191ST ST APT 225 | ||||||||
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| City: | NORTH MIAMI BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331794155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052820333 | ||||||||
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| Practice Location | |||||||||
| Address1: | 50 COURT ST STE 1002 | ||||||||
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| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112014821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126955122 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2016 | ||||||||
| LastUpdateDate: | 05/24/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 018914-1 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.