Provider Demographics
NPI:1730255688
Name:WEISZ, JEFFREY DANIEL (DC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DANIEL
Last Name:WEISZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:GUILDERLAND CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:12085
Mailing Address - Country:US
Mailing Address - Phone:518-861-5744
Mailing Address - Fax:518-861-5743
Practice Address - Street 1:458 ROUTE 146
Practice Address - Street 2:
Practice Address - City:GUILDERLAND CENTER
Practice Address - State:NY
Practice Address - Zip Code:12085
Practice Address - Country:US
Practice Address - Phone:518-861-5744
Practice Address - Fax:518-861-5743
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0033941111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC1684Medicare ID - Type Unspecified