Provider Demographics
NPI:1811282304
Name:WEISS, KEVIN ANDREW (DO)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ANDREW
Last Name:WEISS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:200 W 57TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3211
Mailing Address - Country:US
Mailing Address - Phone:212-399-7000
Mailing Address - Fax:877-413-3872
Practice Address - Street 1:200 W 57TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3211
Practice Address - Country:US
Practice Address - Phone:212-399-7000
Practice Address - Fax:877-413-3872
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2016-04-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY276674204D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine