Provider Demographics
NPI:1922324151
Name:WEISS, SIMONE (LMT, LAC)
Entity Type:Individual
Prefix:
First Name:SIMONE
Middle Name:
Last Name:WEISS
Suffix:
Gender:F
Credentials:LMT, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88-10 34TH AVE
Mailing Address - Street 2:5H
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-3418
Mailing Address - Country:US
Mailing Address - Phone:201-783-4566
Mailing Address - Fax:
Practice Address - Street 1:88-10 34TH AVE
Practice Address - Street 2:5H
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-3418
Practice Address - Country:US
Practice Address - Phone:201-783-4566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-13
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006373-01171100000X
NY023680225700000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist