Provider Demographics
NPI:1083783427
Name:WEIDMANN, JEFFREY D (LAC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:D
Last Name:WEIDMANN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-5243
Mailing Address - Country:US
Mailing Address - Phone:718-855-4850
Mailing Address - Fax:718-855-4860
Practice Address - Street 1:518 HENRY ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-5243
Practice Address - Country:US
Practice Address - Phone:718-855-4850
Practice Address - Fax:718-855-4860
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1720171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP2640834OtherOXFORD PROVIDER #