Provider Demographics
NPI:1366625162
Name:WEISS, JEFFREY G (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:G
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:44 STATE RT 23
Mailing Address - Street 2:SUITE 6
Mailing Address - City:RIVERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07457-1603
Mailing Address - Country:US
Mailing Address - Phone:973-248-9199
Mailing Address - Fax:973-248-9299
Practice Address - Street 1:44 STATE RT 23
Practice Address - Street 2:SUITE 6
Practice Address - City:RIVERDALE
Practice Address - State:NJ
Practice Address - Zip Code:07457-1603
Practice Address - Country:US
Practice Address - Phone:973-248-9199
Practice Address - Fax:973-248-9299
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07379200207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3440856OtherAETNA
NJI006422Medicare UPIN