Provider Demographics
NPI:1669547014
Name:WEISS, JONATHAN HYMAN (PHD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:HYMAN
Last Name:WEISS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 ARGYLE RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-3401
Mailing Address - Country:US
Mailing Address - Phone:718-284-5095
Mailing Address - Fax:212-737-2575
Practice Address - Street 1:10 E 78TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-1713
Practice Address - Country:US
Practice Address - Phone:212-737-2575
Practice Address - Fax:212-737-2575
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3935103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV10311Medicare ID - Type Unspecified