Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | 40QA01381100 | NJ |
NPI | 1144282252 |
---|---|
Provider Name | Mr. Leigh Jordan Weiss |
First Address | Hoboken, NJ 07030-4759 |
Second Address | East Rutherford, NJ 07073-2140 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2006 |
Last Update Date | 20/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
984835 | NATA (01) | NJ |