Provider Demographics
NPI:1710253059
Name:WEISSMAN, IRIS (MS RD CDN)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:WEISSMAN
Suffix:
Gender:F
Credentials:MS RD CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 POND VIEW LANE
Mailing Address - Street 2:
Mailing Address - City:CHAPPAQUA
Mailing Address - State:NY
Mailing Address - Zip Code:10514
Mailing Address - Country:US
Mailing Address - Phone:914-238-5804
Mailing Address - Fax:815-377-6041
Practice Address - Street 1:67 POND VIEW LANE
Practice Address - Street 2:
Practice Address - City:CHAPPAQUA
Practice Address - State:NY
Practice Address - Zip Code:10514
Practice Address - Country:US
Practice Address - Phone:914-238-5804
Practice Address - Fax:815-377-6041
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR510138133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered