Provider Demographics
NPI:1720509953
Name:WEISS, JONATHAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:WEISS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ZVI
Other - Middle Name:
Other - Last Name:WEISS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:2920 BROADWAY FL 8
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-7164
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2920 BROADWAY FL 8
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-7164
Practice Address - Country:US
Practice Address - Phone:347-504-1067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist