Provider Demographics
NPI:1477518306
Name:WEISS, KERRY IRA (MD)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:IRA
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:2 CONSTITUTION CT APT 807
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-6729
Mailing Address - Country:US
Mailing Address - Phone:312-898-2258
Mailing Address - Fax:201-526-4211
Practice Address - Street 1:254 EASTON AVE
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1766
Practice Address - Country:US
Practice Address - Phone:732-565-5448
Practice Address - Fax:732-745-8725
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY159566-012080N0001X
NJMA589822080N0001X
PAMD039280L2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001103307Medicaid
NJ5365805Medicaid
PA001103307Medicaid