Provider Demographics
NPI:1528343431
Name:WEISER, JANE (EDD, RN, IBCLC)
Entity type:Individual
Prefix:PROF
First Name:JANE
Middle Name:
Last Name:WEISER
Suffix:
Gender:F
Credentials:EDD, RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 S GATE RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-1315
Mailing Address - Country:US
Mailing Address - Phone:516-376-7579
Mailing Address - Fax:
Practice Address - Street 1:16 S GATE RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-1315
Practice Address - Country:US
Practice Address - Phone:516-376-7579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY29078-1, 192-11042163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant