Individual
MR. KEVIN WEISBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, ATC
Contact information
Practice address
2641 KENNEDY BLVD, JERSEY CITY, NJ 07306-5943
(201) 761-7326
Mailing address
2641 KENNEDY BLVD, JERSEY CITY, NJ 07306-5943
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
25MT00141900
NJ
Other
Enumeration date
01/08/2008
Last updated
01/08/2008
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