Provider Demographics
NPI:1619713765
Name:WEISS, IDA J
Entity type:Individual
Prefix:
First Name:IDA
Middle Name:J
Last Name:WEISS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HERKIMER
Mailing Address - State:NY
Mailing Address - Zip Code:13350-1216
Mailing Address - Country:US
Mailing Address - Phone:315-867-1664
Mailing Address - Fax:315-867-1431
Practice Address - Street 1:301 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350-1216
Practice Address - Country:US
Practice Address - Phone:315-867-1664
Practice Address - Fax:315-867-1431
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator