Provider Demographics
NPI:1164540019
Name:WEISBROT, FREDERICK J (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:J
Last Name:WEISBROT
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:PO BOX 393
Mailing Address - Street 2:190 EAGLE ROCK AVENUE
Mailing Address - City:ROSELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07068-0393
Mailing Address - Country:US
Mailing Address - Phone:201-997-2044
Mailing Address - Fax:201-997-2041
Practice Address - Street 1:190 EAGLE ROCK AVENUE
Practice Address - Street 2:
Practice Address - City:ROSELAND
Practice Address - State:NJ
Practice Address - Zip Code:07068-0393
Practice Address - Country:US
Practice Address - Phone:201-997-2044
Practice Address - Fax:201-997-2041
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA033096002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3060403Medicaid
61125Medicare UPIN
NJ3060403Medicaid