Provider Demographics
NPI:1891754479
Name:WEISS, HARVEY FRED (OD)
Entity Type:Individual
Prefix:
First Name:HARVEY
Middle Name:FRED
Last Name:WEISS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 ELM ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07436-1903
Mailing Address - Country:US
Mailing Address - Phone:201-337-2227
Mailing Address - Fax:201-337-1834
Practice Address - Street 1:14 ELM ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:NJ
Practice Address - Zip Code:07436-1903
Practice Address - Country:US
Practice Address - Phone:201-337-2227
Practice Address - Fax:201-337-1834
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3961152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3337103Medicaid
NJ479432Medicare ID - Type Unspecified
NJ3337103Medicaid