Provider Demographics
NPI:1326120080
Name:WEISFELD, LARRY D (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:D
Last Name:WEISFELD
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 1:515 CHURCH STREET
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BOUND BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08805-1743
Mailing Address - Country:US
Mailing Address - Phone:732-356-7283
Mailing Address - Fax:732-356-0432
Practice Address - Street 1:515 CHURCH STREET
Practice Address - Street 2:SUITE 4
Practice Address - City:BOUND BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08805-1743
Practice Address - Country:US
Practice Address - Phone:732-356-7283
Practice Address - Fax:732-356-0432
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA36092207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0421707Medicaid
C53914Medicare UPIN
NJ0421707Medicaid