Provider Demographics
NPI:1336029743
Name:WEBER, JAKE JOSEPH
Entity type:Individual
Prefix:
First Name:JAKE
Middle Name:JOSEPH
Last Name:WEBER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 GREEN BAY DR
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6235
Mailing Address - Country:US
Mailing Address - Phone:330-506-1799
Mailing Address - Fax:
Practice Address - Street 1:2395 GARDEN WAY STE 101
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-5209
Practice Address - Country:US
Practice Address - Phone:724-981-2522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty