Healthcare Provider Details

I. General information

NPI: 1578164331
Provider Name (Legal Business Name): MEREDITH WEISS, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 80TH ST APT 1D
NEW YORK NY
10075-0350
US

IV. Provider business mailing address

111 E 80TH ST APT 1D
NEW YORK NY
10075-0350
US

V. Phone/Fax

Practice location:
  • Phone: 646-820-6572
  • Fax: 718-682-3808
Mailing address:
  • Phone: 917-208-6009
  • Fax: 718-682-3808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MEREDITH WEISS
Title or Position: OWNER
Credential: MD
Phone: 646-820-6572