Provider Demographics
NPI:1669803722
Name:WEISS, MARTIN
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:WEISS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MORDECHAI
Other - Middle Name:
Other - Last Name:WEISS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5656
Mailing Address - Country:US
Mailing Address - Phone:718-787-1100
Mailing Address - Fax:718-787-9598
Practice Address - Street 1:425 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-1629
Practice Address - Country:US
Practice Address - Phone:718-787-1100
Practice Address - Fax:718-787-9598
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health