Provider Demographics
NPI:1326478819
Name:DSWLLC
Entity Type:Organization
Organization Name:DSWLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SMALLWOOD
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:RNFA
Authorized Official - Phone:908-668-1766
Mailing Address - Street 1:725 OLD RARITAN RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1021
Mailing Address - Country:US
Mailing Address - Phone:908-668-1766
Mailing Address - Fax:
Practice Address - Street 1:725 OLD RARITAN RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1021
Practice Address - Country:US
Practice Address - Phone:908-668-1766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR08930300163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Multi-Specialty