Healthcare Provider Details

I. General information

NPI: 1235367418
Provider Name (Legal Business Name): LISA HUTCHISON WEISS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 BAINBRIDGE AVE
BRONX NY
10467-2802
US

IV. Provider business mailing address

3340 BAINBRIDGE AVE
BRONX NY
10467-2802
US

V. Phone/Fax

Practice location:
  • Phone: 718-696-3011
  • Fax: 718-405-5953
Mailing address:
  • Phone: 718-696-3011
  • Fax: 718-405-5953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number61467953
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number285693
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number61467953
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number285693
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number61467953
License Number StateWA
# 6
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number285693
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: