Provider Demographics
NPI:1407166382
Name:PAUL WEISSMAN P.C.
Entity Type:Organization
Organization Name:PAUL WEISSMAN P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-379-7990
Mailing Address - Street 1:9 GAIL CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-2212
Mailing Address - Country:US
Mailing Address - Phone:973-379-7990
Mailing Address - Fax:973-379-1681
Practice Address - Street 1:377 JERSEY AVE
Practice Address - Street 2:SUITE 460
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-4325
Practice Address - Country:US
Practice Address - Phone:201-332-4110
Practice Address - Fax:201-332-4122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04353000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1575309Medicaid
613507Medicare PIN
E55112Medicare UPIN