Provider Demographics
NPI:1669441648
Name:WEISBERG, JAY G (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:G
Last Name:WEISBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:260 CHAPMAN RD
Mailing Address - Street 2:SUITE 100E
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-5490
Mailing Address - Country:US
Mailing Address - Phone:302-731-1558
Mailing Address - Fax:302-731-0220
Practice Address - Street 1:260 CHAPMAN RD
Practice Address - Street 2:SUITE 100E
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5490
Practice Address - Country:US
Practice Address - Phone:302-731-1558
Practice Address - Fax:302-731-0220
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC100015002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1123099OtherCIGNA BEHAVIORAL HEALTH
DE510404545OtherBLUE CROSS OF DELAWARE
DE173201OtherCOMPSYCH
DE490806Medicare ID - Type UnspecifiedMEDICARE
DE510404545OtherBLUE CROSS OF DELAWARE