Provider Demographics
NPI:1730601881
Name:WEAVER, JOSEPH PATRICK (NPP)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:PATRICK
Last Name:WEAVER
Suffix:
Gender:M
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7844 226TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-3625
Mailing Address - Country:US
Mailing Address - Phone:646-752-3552
Mailing Address - Fax:
Practice Address - Street 1:222 STATION PLZ N STE 350A
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3814
Practice Address - Country:US
Practice Address - Phone:516-663-2691
Practice Address - Fax:516-663-8971
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-11
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY402169363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health