NPIMap

Individual provider Active NPI

Shennan Aibel Weiss, M.D., PH.D.

  • Neurology Physician
  • Stony Brook, NY
National Provider Identifier
1033436662
Registry record updated May 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
MD457821 Issued in PA
Practice address
100 Nicolls Rd RM 20
Stony Brook, NY 11794-5211
Phone
(631) 444-2599
NPI assigned
Apr 21, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 14, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Epilepsy Physician 2084E0001X 300830-01 NY
Neurology Physician 2084N0400X MD457821 PA Primary

Addresses

Primary practice location

100 Nicolls Rd RM 20
Stony Brook, NY 11794-5211

Mailing address

909 Walnut St
2ND Floor
Philadelphia, PA 19107-5211
Phone (215) 955-1234

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200416002524 NY Practitioner - EpileptologistsPractitioner - Neurology 5698997179 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
EpileptologistsAlso: Neurology
Education
Albert Einstein College of Medicine of Yeshiva University, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

100 Nicolls Rd
Stony Brook, NY 11794-0001
Phone (631) 444-2599

Lauterbur Dr
Stony Brook, NY 11794-0001
Phone (631) 638-1000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
300830-01NYMDEpilepsy Physician
MD457821PAMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Brookdale Hospital Medical Center CurrentSince Mar 14, 2020 Accepting new patients
Neurology Associates of Stony Brook, University Faculty Practice Corpo Neurology CurrentSince Jun 3, 2024 Accepting new patients
The Brookdale Hospital Medical Center CurrentSince Mar 14, 2020 Accepting new patients
Maimonides Medical Center Current Accepting new patients
University Hospital at Stony Brook Past Accepting new patients

Locations

1235 Linden Blvd
Fl 2
Brooklyn, NY 11212
Phone (718) 240-7143

1 Brookdale Plz
Brooklyn, NY 11212
Phone (718) 240-5212

4 Smith Haven Mall
Ste 105
Lake Grove, NY 11755

100 Nicolls Rd
Stony Brook, NY 11794
Phone (631) 444-1560

100 Nicolls Rd
Rm 20
Stony Brook, NY 11794
Phone (631) 444-7646

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678

Interoperability endpoints

  • Direct secure messaging: sweiss1369855@nychhc.direct-ci.com
  • Direct secure messaging: shennanweiss@mai.allscriptsdirect.net

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1271808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715644800000",
    "number": "1033436662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 WALNUT ST",
            "address_2": "2ND FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191075211",
            "telephone_number": "215-955-1234",
            "fax_number": "215-955-3745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 NICOLLS RD RM 20",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117945211",
            "telephone_number": "631-444-2599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEISS",
        "first_name": "SHENNAN",
        "middle_name": "AIBEL",
        "name_prefix": "Dr.",
        "credential": "M.D., PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-04-21",
        "last_updated": "2024-05-14",
        "certification_date": "2024-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084E0001X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Epilepsy",
            "state": "NY",
            "license": "300830-01",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "PA",
            "license": "MD457821",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stony Brook, NY

Sources for this page

Verify at the official NPI Registry.