Provider Demographics
NPI:1598027872
Name:WEBER, JO ANN
Entity Type:Individual
Prefix:MRS
First Name:JO
Middle Name:ANN
Last Name:WEBER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JO
Other - Middle Name:ANN
Other - Last Name:LIPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:179 BALTIC ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-6173
Mailing Address - Country:US
Mailing Address - Phone:718-834-1974
Mailing Address - Fax:718-834-1974
Practice Address - Street 1:179 BALTIC ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-6173
Practice Address - Country:US
Practice Address - Phone:718-834-1974
Practice Address - Fax:718-834-1974
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist