Provider Demographics
NPI:1760933394
Name:WEICHSELBAUM, LEAH (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:
Last Name:WEICHSELBAUM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-1783
Mailing Address - Country:US
Mailing Address - Phone:718-260-4640
Mailing Address - Fax:718-260-4646
Practice Address - Street 1:517 PARK AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-1783
Practice Address - Country:US
Practice Address - Phone:718-260-4640
Practice Address - Fax:718-260-4646
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY341175363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily