Provider Demographics
NPI:1114011095
Name:VEBER, MIRTA (MD)
Entity Type:Individual
Prefix:
First Name:MIRTA
Middle Name:
Last Name:VEBER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 WESTWOOD AVENUE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:RIVER VALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07675
Mailing Address - Country:US
Mailing Address - Phone:201-358-6774
Mailing Address - Fax:201-358-1140
Practice Address - Street 1:250 OLD HOOK ROAD
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675
Practice Address - Country:US
Practice Address - Phone:201-358-6776
Practice Address - Fax:201-358-1891
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA568132080N0001X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics