Provider Demographics
NPI:1265520225
Name:WEISSBERG, ROBERT A (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:WEISSBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:WHITNEY M. YOUNG JR. HEALTH CENTER, INC.
Mailing Address - Street 2:920 LARK DRIVE
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12207-1300
Mailing Address - Country:US
Mailing Address - Phone:518-465-4771
Mailing Address - Fax:518-320-3022
Practice Address - Street 1:6 102ND ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-1152
Practice Address - Country:US
Practice Address - Phone:518-833-6900
Practice Address - Fax:518-833-6919
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138667207Q00000X
NY0101205R261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB82283Medicare UPIN