MEDICARE: SIMONE WEISS L.M.T., L.A.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	006373-01	NY
2	225700000X	Massage Therapist	023680	NY
3	172V00000X	Community Health Worker	023680	NY

General Provider Information

NPI Number	:	1922324151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIMONE WEISS L.M.T., L.A.C.

Provider Business Mailing Address
First Line	:	88-10 34TH AVE
Second Line	:	5H
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-3418
Country	:	US
Telephone Number	:	201-783-4566
Fax Number	:

Provider Business Practice Location Address
First Line	:	88-10 34TH AVE
Second Line	:	5H
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-3418
Country	:	US
Telephone Number	:	201-783-4566
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2010
Last Update Date	:	01/12/2024

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