Provider Demographics
NPI:1063656932
Name:WEISZ, KAREN B (NP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:B
Last Name:WEISZ
Suffix:
Gender:F
Credentials:NP
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 27036
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-7036
Mailing Address - Country:US
Mailing Address - Phone:212-305-0914
Mailing Address - Fax:212-305-4343
Practice Address - Street 1:622 W 168TH ST
Practice Address - Street 2:PH14
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3720
Practice Address - Country:US
Practice Address - Phone:212-305-0914
Practice Address - Fax:212-305-4343
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY331147363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01736227Medicaid
NY01736227Medicaid