Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | X0042581 | NY |
Y | 111NI0013X | Independent Medical Examiner | NYSIMEC042582B | NY |
NPI | 1801065016 |
---|---|
Provider Name | Mr. Roger Allen Weiss |
First Address | Far Hills, NJ 07931 |
Second Address | Far Hills, NJ 07931 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2008 |
Last Update Date | 22/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C042582B | NYS IME NUMBER (01) | NY |
X0042581 | LIC NUMBER NY (01) | NY |