Active NPI
Gordon S Weiss, MD
- Child & Adolescent Psychiatry Physician
- East Haven, CT
National Provider Identifier
1174600258
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child & Adolescent Psychiatry Physician
- License
- 035345
- Practice address
- 595 Thompson Avenue
East Haven Counseling & Community Services
East Haven, CT 06512 - Phone
- (203) 468-3297
- Fax
- (203) 468-3334
- NPI assigned
- Nov 1, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Child & Adolescent Psychiatry Physician | 2084P0804X | 035345 | CT | Primary |
Addresses
Primary practice location
595 Thompson Avenue
East Haven Counseling & Community Services
East Haven, CT 06512
Mailing address
595 Thompson Avenue
East Haven Counseling & Community Services
East Haven, CT 06512
Phone (203) 468-3297
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jun 30, 2022 through Jun 30, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 035345 | CT | MD | Child & Adolescent Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1174600258",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "595 THOMPSON AVENUE",
"address_2": "EAST HAVEN COUNSELING & COMMUNITY SERVICES",
"city": "EAST HAVEN",
"state": "CT",
"postal_code": "06512",
"telephone_number": "203-468-3297",
"fax_number": "203-468-3334"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "595 THOMPSON AVENUE",
"address_2": "EAST HAVEN COUNSELING & COMMUNITY SERVICES",
"city": "EAST HAVEN",
"state": "CT",
"postal_code": "06512",
"telephone_number": "203-468-3297",
"fax_number": "203-468-3334"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEISS",
"first_name": "GORDON",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-01",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "CT",
"license": "035345",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Haven, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.