Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 25MA07379200 | NJ |
NPI | 1366625162 |
---|---|
Provider Name | Dr. Jeffrey G Weiss |
First Address | Riverdale, NJ 07457-1603 |
Second Address | Riverdale, NJ 07457-1603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2007 |
Last Update Date | 07/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3440856 | AETNA (01) | NJ |
I006422 | (02) | NJ |