Provider Demographics
NPI:1144282252
Name:WEISS, LEIGH JORDAN (ATC, PT/DPT)
Entity type:Individual
Prefix:MR
First Name:LEIGH
Middle Name:JORDAN
Last Name:WEISS
Suffix:
Gender:M
Credentials:ATC, PT/DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 BLOOMFIELD ST
Mailing Address - Street 2:APT. 3
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-4759
Mailing Address - Country:US
Mailing Address - Phone:848-228-0246
Mailing Address - Fax:
Practice Address - Street 1:1925 GIANTS DR
Practice Address - Street 2:TIMEX PERFORMANCE CENTER
Practice Address - City:EAST RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07073-2140
Practice Address - Country:US
Practice Address - Phone:201-935-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
NJ40QA013811002251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ984835OtherNATA