Provider Demographics
NPI:1316946247
Name:WEISS, JEFFREY KURT (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:KURT
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 E HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-1034
Mailing Address - Country:US
Mailing Address - Phone:212-533-5090
Mailing Address - Fax:212-533-7053
Practice Address - Street 1:81 IRVING PL # 1F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2208
Practice Address - Country:US
Practice Address - Phone:212-533-5090
Practice Address - Fax:212-533-7053
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY176918207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01851129Medicaid
NY01851129Medicaid
NY32E622Medicare PIN