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General NPI Number Information
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NPI Number | 1083881072
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Entity Type | Individual
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Provider Name | JENNIFER DIANE WEISS JENNIFER WEISS, LAC
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Gender | Female
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Dates
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Enumeration Date | 05/09/2008
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Last Update Date | 10/14/2016
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Provider Practice Location Address
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Address Line | 130 FAIRCHILD AVE 305
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City | FAIRFIELD
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State | CT
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Zip | 06825-4848
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Country | US
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Telephone | 914-804-2864
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Fax |
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Provider Business Mailing Address
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Address Line | 130 FAIRCHILD AVE 305
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City | FAIRFIELD
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State | CT
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Zip | 06825
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 000446
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 105
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License Number State | CT
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