Provider Demographics
NPI:1790855815
Name:WEBER, RENATA V (MD)
Entity Type:Individual
Prefix:
First Name:RENATA
Middle Name:V
Last Name:WEBER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 ROUTE 17
Mailing Address - Street 2:11TH FLOOR, ROOM 11056
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-2574
Mailing Address - Country:US
Mailing Address - Phone:201-549-8860
Mailing Address - Fax:201-549-8861
Practice Address - Street 1:201 ROUTE 17
Practice Address - Street 2:11TH FLOOR, ROOM 11056
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-2574
Practice Address - Country:US
Practice Address - Phone:201-549-8860
Practice Address - Fax:201-549-8861
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2125342082S0105X
NJ25MA089862002082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand