Provider Demographics
NPI:1639317654
Name:WEINER, SHOSHANA E (PA)
Entity Type:Individual
Prefix:MRS
First Name:SHOSHANA
Middle Name:E
Last Name:WEINER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:17 KINGSFIELD DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3086
Mailing Address - Country:US
Mailing Address - Phone:732-886-5423
Mailing Address - Fax:732-886-5423
Practice Address - Street 1:40 BEY LEA RD
Practice Address - Street 2:SUITE B, BUILDING B 203
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2900
Practice Address - Country:US
Practice Address - Phone:732-341-5180
Practice Address - Fax:732-349-1507
Is Sole Proprietor?:No
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00211800363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical