Provider Demographics
NPI:1629337720
Name:KORN, ADA WEISKOPF (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ADA
Middle Name:WEISKOPF
Last Name:KORN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 W GARDEN RD
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-1728
Mailing Address - Country:US
Mailing Address - Phone:914-833-3751
Mailing Address - Fax:914-833-3751
Practice Address - Street 1:88 W GARDEN RD
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-1728
Practice Address - Country:US
Practice Address - Phone:914-833-3751
Practice Address - Fax:914-833-3751
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008961-1103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist