| Doctor Name: | DR. JAY IRA WEISSMAN |
| NPI Number: | 1104986454 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | B10000503 |
| Business Practice Address: | 12b Smedley Ln Suite 1 Newtown Square, PA - 190733206 |
| Business Phone Number: | 6103563724 |
| Business Fax Number: | 6106580927 |
| Mailing Address: | 12b Smedley Ln, Suite 1 NEWTOWN SQUARE |
| State: | PA |
| Postal Code: | 190733206 |
| Phone Number: | 6103563724 |
| Fax Number: | 6106580927 |
| NPI Enumeration Date: | 12/09/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | B10000503 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | DE |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |