Provider Demographics
NPI:1104822451
Name:WEISER, PAUL J (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:WEISER
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 1:3625 QUAKERBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1207
Mailing Address - Country:US
Mailing Address - Phone:609-689-1600
Mailing Address - Fax:609-689-1200
Practice Address - Street 1:2501 KUSER RD
Practice Address - Street 2:STE 514
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08691-3800
Practice Address - Country:US
Practice Address - Phone:609-585-8800
Practice Address - Fax:609-585-1825
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA030317002085R0202X
PAMD017295E2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00842514Medicaid
NJ0511501Medicaid
PA00842514Medicaid
NJ0511501Medicaid
NJ186823Medicare PIN