Provider Demographics
NPI:1730181959
Name:WEISBERG, SAMUEL (CPO)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:WEISBERG
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 COAL AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-5206
Mailing Address - Country:US
Mailing Address - Phone:505-248-0303
Mailing Address - Fax:505-248-1611
Practice Address - Street 1:1018 COAL AVE SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-5206
Practice Address - Country:US
Practice Address - Phone:505-248-0303
Practice Address - Fax:505-248-1611
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMT6249Medicaid
NM0653630001Medicare NSC