Provider Demographics
NPI:1265471437
Name:WEESNER, DAVID RUSSELL (AUD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RUSSELL
Last Name:WEESNER
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 NEW RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1299
Mailing Address - Country:US
Mailing Address - Phone:609-926-0700
Mailing Address - Fax:609-926-4870
Practice Address - Street 1:222 NEW RD
Practice Address - Street 2:SUITE 301
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1299
Practice Address - Country:US
Practice Address - Phone:609-926-0700
Practice Address - Fax:609-926-4870
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00026400231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ01000648600OtherAMERICAID
NJ0423673000OtherAMERIHEALTH HMO
NJ1140429OtherNJ HEALTH
NJP11203948OtherMULTIPLAN
NJ114193OtherAMERIGROUP
NJ657479OtherKEYSTONE
NJ7939507Medicaid
NJ2131888OtherAETNA
NJ2189524OtherUNITED
NJP2162112OtherOXFORD
NJ657479OtherAMERIHEALTH PPO
NH205051OtherAMERIHEALTH 65
NJ01000648600OtherAMERICAID