Provider Demographics
NPI:1467515916
Name:WEISS, ELIZABETH CLARA (RN, BSN)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:CLARA
Last Name:WEISS
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MANDALAY DR
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-2632
Mailing Address - Country:US
Mailing Address - Phone:845-471-0541
Mailing Address - Fax:
Practice Address - Street 1:41 BIRCH TRL
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-5727
Practice Address - Country:US
Practice Address - Phone:845-225-4430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY490539163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02224880Medicaid