Provider Demographics
NPI:1801868823
Name:WAISS, SAMUEL (DPM)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:WAISS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2223 CONEY ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-3337
Mailing Address - Country:US
Mailing Address - Phone:718-375-6096
Mailing Address - Fax:718-375-6125
Practice Address - Street 1:2223 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-3337
Practice Address - Country:US
Practice Address - Phone:718-375-6096
Practice Address - Fax:718-375-6125
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004308-1213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT51403Medicare UPIN
NYP44582Medicare PIN