Healthcare Provider Details

I. General information

NPI: 1477518306
Provider Name (Legal Business Name): KERRY IRA WEISS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 EASTON AVE
NEW BRUNSWICK NJ
08901-1766
US

IV. Provider business mailing address

2 CONSTITUTION CT APT 807
HOBOKEN NJ
07030-6729
US

V. Phone/Fax

Practice location:
  • Phone: 732-565-5448
  • Fax: 732-745-8725
Mailing address:
  • Phone: 312-898-2258
  • Fax: 201-526-4211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number159566-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMA58982
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMD039280L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: