Provider Demographics
NPI:1497709638
Name:WEISSMAN, TANYA (MD)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:
Last Name:WEISSMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 BRUNSWICK WOODS DR
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5601
Mailing Address - Country:US
Mailing Address - Phone:732-238-0080
Mailing Address - Fax:732-238-0070
Practice Address - Street 1:69 BRUNSWICK WOODS DR
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5601
Practice Address - Country:US
Practice Address - Phone:732-238-0080
Practice Address - Fax:732-238-0070
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25 MA07653000208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ101788Medicaid
NJI54263Medicare UPIN