Provider Demographics
NPI:1528392446
Name:ANDREW B. WEISS, M.D., LLC
Entity Type:Organization
Organization Name:ANDREW B. WEISS, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPAEDIC SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-226-0825
Mailing Address - Street 1:1140 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE 216
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-7130
Mailing Address - Country:US
Mailing Address - Phone:973-226-0825
Mailing Address - Fax:973-226-3853
Practice Address - Street 1:1140 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 216
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-7130
Practice Address - Country:US
Practice Address - Phone:973-226-0825
Practice Address - Fax:973-226-3853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03225200174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE56974Medicare UPIN