Provider Demographics
NPI:1558437251
Name:WEISS, GABRIELLA ANTIONETTE (MD)
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:ANTIONETTE
Last Name:WEISS
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 1:842 CLIFTON AVE
Mailing Address - Street 2:SUITE #4
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013
Mailing Address - Country:US
Mailing Address - Phone:973-777-2440
Mailing Address - Fax:973-777-2427
Practice Address - Street 1:842 CLIFTON AVE
Practice Address - Street 2:SUITE #4
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013
Practice Address - Country:US
Practice Address - Phone:973-777-2440
Practice Address - Fax:973-777-2427
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA42491207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1713001Medicaid
D19025Medicare UPIN
NJWE453803Medicare ID - Type Unspecified