Provider Demographics
NPI:1558448605
Name:WEISS, CAROL (RN P)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:WEISS
Suffix:
Gender:F
Credentials:RN P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PRACTICE ASSOCIATES MEDICAL GROUP PA
Mailing Address - Street 2:PO BOX 23831
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07189-0001
Mailing Address - Country:US
Mailing Address - Phone:973-656-6280
Mailing Address - Fax:
Practice Address - Street 1:492 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2142
Practice Address - Country:US
Practice Address - Phone:973-971-7184
Practice Address - Fax:973-290-8349
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN06712800363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJS44903Medicare UPIN