Provider Demographics
NPI:1144263799
Name:ZWEIG, RICHARD A (PHD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:ZWEIG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 PEPPERDAY AVE
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-2411
Mailing Address - Country:US
Mailing Address - Phone:516-944-0019
Mailing Address - Fax:
Practice Address - Street 1:585 PLANDOME RD
Practice Address - Street 2:SUITE 106
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-1971
Practice Address - Country:US
Practice Address - Phone:718-430-3958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010287-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01352923FMedicaid
NY01352923FMedicaid
NY00054Medicare ID - Type UnspecifiedGHI
NYV67561Medicare ID - Type UnspecifiedBC/BS