Provider Demographics
NPI:1356407506
Name:WEISS, KENNETH JAY (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:JAY
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6809 CRESHEIM RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-2640
Mailing Address - Country:US
Mailing Address - Phone:215-844-6793
Mailing Address - Fax:215-844-0231
Practice Address - Street 1:333 E CITY AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1501
Practice Address - Country:US
Practice Address - Phone:610-660-7728
Practice Address - Fax:610-667-7914
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD022359E2084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry