Provider Demographics
NPI:1043272768
Name:WEIGEL, PETER JOHN (MD)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:JOHN
Last Name:WEIGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 SOUTH AVE E
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-1459
Mailing Address - Country:US
Mailing Address - Phone:908-233-1444
Mailing Address - Fax:908-654-0226
Practice Address - Street 1:324 SOUTH AVE E
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-1459
Practice Address - Country:US
Practice Address - Phone:908-233-1444
Practice Address - Fax:908-654-0226
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05100000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
517271OtherAETNA
0441680000OtherAMERIHEALTH
1014139OtherCIGNA
F06236OtherHEALTH NET
UP168OtherOXFORD HEALTH PLANS
NJ5227607Medicaid
UP168OtherOXFORD HEALTH PLANS
613472AGGMedicare ID - Type Unspecified
NJ5227607Medicaid