Provider Demographics
NPI:1396851846
Name:WEBER, JANE E (NP)
Entity Type:Individual
Prefix:MR
First Name:JANE
Middle Name:E
Last Name:WEBER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-9634
Mailing Address - Country:US
Mailing Address - Phone:518-235-8302
Mailing Address - Fax:
Practice Address - Street 1:31 LOWER HUDSON AVE
Practice Address - Street 2:
Practice Address - City:GREEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:12183-1014
Practice Address - Country:US
Practice Address - Phone:518-272-9140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY360055207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00437138OtherRAILROAD MEDICARE
NYDD0224Medicare ID - Type Unspecified