Provider Demographics
NPI:1609838986
Name:ALWEISS, GARY S (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:S
Last Name:ALWEISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ROCKWOOD PL
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4957
Mailing Address - Country:US
Mailing Address - Phone:201-894-5805
Mailing Address - Fax:201-894-1956
Practice Address - Street 1:25 ROCKWOOD PL
Practice Address - Street 2:SUITE 110
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4957
Practice Address - Country:US
Practice Address - Phone:201-894-5805
Practice Address - Fax:201-894-1956
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ592662084N0400X
NY1811232084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F25445Medicare UPIN
NJ745415NP0Medicare ID - Type Unspecified