Healthcare Provider Details

I. General information

NPI: 1720168842
Provider Name (Legal Business Name): YAACOV WEISS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 MADISON AVE SUITE 11E
NEW YORK NY
10016-5421
US

IV. Provider business mailing address

161 MADISON AVE SUITE 11E
NEW YORK NY
10016-5421
US

V. Phone/Fax

Practice location:
  • Phone: 212-750-7404
  • Fax: 212-750-7404
Mailing address:
  • Phone: 212-750-7404
  • Fax: 212-750-7404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number203567
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA13152400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: