Individual
LORETA WEISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15813 72ND AVE, FRESH MEADOWS, NY 11365-1140
(718) 380-7600
(718) 380-6675
Mailing address
3228 TENBROECK AVE, BRONX, NY 10469-5011
(347) 641-0864
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
04/08/2018
Last updated
04/08/2018
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