Provider Demographics
NPI:1235235128
Name:WEISBERG, LAWRENCE S (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:S
Last Name:WEISBERG
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 1:3 COOPER PLZ
Mailing Address - Street 2:SUITE 215
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1438
Mailing Address - Country:US
Mailing Address - Phone:856-757-7844
Mailing Address - Fax:856-757-7778
Practice Address - Street 1:3 COOPER PLZ
Practice Address - Street 2:SUITE 215
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1438
Practice Address - Country:US
Practice Address - Phone:856-757-7844
Practice Address - Fax:856-757-7778
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA49927207RN0300X
PAMD028401E207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
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NJ1243124OtherUNITED HEALTHCARE
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NJ0000055968OtherOPERATING ENGINEERS
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NJ3K6115OtherHEALTHNET, INC
NJ13564OtherUNIVERSITY HEALTH PLAN
C58261Medicare UPIN
NJ3K6115OtherHEALTHNET, INC