Provider Demographics
NPI:1578634473
Name:WEBER, CHERYL (NP)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:
Last Name:WEBER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 W. JIMMIE LEEDS ROAD
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NJ
Mailing Address - Zip Code:08240-0723
Mailing Address - Country:US
Mailing Address - Phone:609-652-7000
Mailing Address - Fax:609-748-7755
Practice Address - Street 1:61 W. JIMMIE LEEDS ROAD
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NJ
Practice Address - Zip Code:08240-0723
Practice Address - Country:US
Practice Address - Phone:609-652-7000
Practice Address - Fax:609-748-7755
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJN006183000363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0204692Medicaid
NJP67119Medicare UPIN
NJ061403Medicare PIN