Provider Demographics
NPI:1376501486
Name:WEISS, DAVID L (DPM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:WEISS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 S WHITE HORSE PIKE
Mailing Address - Street 2:STE D1
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037
Mailing Address - Country:US
Mailing Address - Phone:609-561-2488
Mailing Address - Fax:609-567-2748
Practice Address - Street 1:777 S WHITE HORSE PIKE
Practice Address - Street 2:STE D1
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037
Practice Address - Country:US
Practice Address - Phone:609-561-2488
Practice Address - Fax:609-567-2748
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD002582213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8334501Medicaid
NJ8334501Medicaid
U80552Medicare UPIN