Provider Demographics
NPI:1235161423
Name:BLUMBERG WEINER, MICHELLE ELENA (PA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ELENA
Last Name:BLUMBERG WEINER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:ELENA
Other - Last Name:BLUMBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 5075
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-5075
Mailing Address - Country:US
Mailing Address - Phone:856-616-8100
Mailing Address - Fax:856-616-1919
Practice Address - Street 1:7600 RIVER ROAD
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047
Practice Address - Country:US
Practice Address - Phone:201-854-5009
Practice Address - Fax:856-616-1919
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP0093500207P00000X
NJ25MP00093500363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine