Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | 045311-1 | NY |
N | 1223P0221X | Pediatric Dentist | 045311-1 | NY |
NPI | 1710947932 |
---|---|
Provider Name | Dr. Jeannine Lori Weiss |
First Address | Roslyn Heights, NY 11577-2419 |
Second Address | Bronx, NY 10451-5504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2006 |
Last Update Date | 08/07/2007 |