Provider Demographics
NPI:1346229275
Name:WEICK, KENNETH PATRICK (PT)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:PATRICK
Last Name:WEICK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E 69TH ST
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5471
Mailing Address - Country:US
Mailing Address - Phone:212-861-0862
Mailing Address - Fax:212-744-0383
Practice Address - Street 1:201 E 69TH ST
Practice Address - Street 2:SUITE 2C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5471
Practice Address - Country:US
Practice Address - Phone:212-861-0862
Practice Address - Fax:212-744-0383
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007325-1208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP986556OtherOXFORD
NYQ43041OtherBCBS
1920619OtherUNITED HEALTHCARE
WK7325OtherATLANTIS
NYQ43041Medicare ID - Type Unspecified