Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | DS040283 | PA |
NPI | 1598003121 |
---|---|
Provider Name | Dr. Jared Scott Weiner |
First Address | Feasterville, PA 19053-4326 |
Second Address | Feasterville, PA 19053-4326 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2013 |
Last Update Date | 27/08/2015 |