Provider Demographics
NPI:1386858876
Name:WEISSE, ALLEN B (MD)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:B
Last Name:WEISSE
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 1:164 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-2808
Mailing Address - Country:US
Mailing Address - Phone:973-379-2322
Mailing Address - Fax:973-379-1372
Practice Address - Street 1:164 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-2808
Practice Address - Country:US
Practice Address - Phone:973-379-2322
Practice Address - Fax:973-379-1372
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA01962900207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA01962900OtherMEDICAL LICENSE