Provider Demographics
NPI:1508995002
Name:WEISS, MOSHE (MA OT)
Entity Type:Individual
Prefix:
First Name:MOSHE
Middle Name:
Last Name:WEISS
Suffix:
Gender:M
Credentials:MA OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2553 E 7TH ST
Mailing Address - Street 2:APT 3 B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6260
Mailing Address - Country:US
Mailing Address - Phone:917-363-9214
Mailing Address - Fax:
Practice Address - Street 1:101 WALTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-4311
Practice Address - Country:US
Practice Address - Phone:718-782-0589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013754225X00000X, 225XP0200X, 225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation