Provider Demographics
NPI:1124514708
Name:WEISSBERGER, KENDRA LEIGH
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:LEIGH
Last Name:WEISSBERGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 COMMUNITY DR STE 400
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3802
Mailing Address - Country:US
Mailing Address - Phone:516-876-4100
Mailing Address - Fax:
Practice Address - Street 1:1983 MARCUS AVE STE C102
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-2006
Practice Address - Country:US
Practice Address - Phone:516-876-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY640013363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily