Provider Demographics
NPI:1730477894
Name:WEITZ, ELENA KAGAN (AUD)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:KAGAN
Last Name:WEITZ
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 BRYDEN PL
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-1627
Mailing Address - Country:US
Mailing Address - Phone:646-436-6382
Mailing Address - Fax:
Practice Address - Street 1:1515 BROAD ST
Practice Address - Street 2:BUILDING B
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3002
Practice Address - Country:US
Practice Address - Phone:973-655-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0023341231H00000X
NJ41YA00091600231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist