Provider Demographics
NPI:1790821015
Name:WEISS FOOT AND ANKLE CENTER
Entity Type:Organization
Organization Name:WEISS FOOT AND ANKLE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:609-561-2488
Mailing Address - Street 1:777 S WHITE HORSE PIKE
Mailing Address - Street 2:SUITE D1
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-2029
Mailing Address - Country:US
Mailing Address - Phone:609-561-2488
Mailing Address - Fax:609-561-2748
Practice Address - Street 1:777 S WHITE HORSE PIKE
Practice Address - Street 2:SUITE D1
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-2029
Practice Address - Country:US
Practice Address - Phone:609-561-2488
Practice Address - Fax:609-561-2748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD002582213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8334501Medicaid
038479Medicare ID - Type Unspecified
NJ8334501Medicaid
NJ5271580001Medicare NSC