Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 25MA036393 | NJ |
NPI | 1003924903 |
---|---|
Provider Name | Lynne Weiss |
First Address | Red Bank, NJ 07701 |
Second Address | New Brunswick, NJ 08901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 21/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2306701 | (05) | NJ |
E13269 | (02) | NJ |