Provider Demographics
NPI:1922040617
Name:WEISMAN, TAMARA (DO)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:
Last Name:WEISMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 RIDGEDALE AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CEDAR KNOLLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07927-1106
Mailing Address - Country:US
Mailing Address - Phone:973-998-6181
Mailing Address - Fax:973-629-1431
Practice Address - Street 1:14 RIDGEDALE AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-1106
Practice Address - Country:US
Practice Address - Phone:973-998-6181
Practice Address - Fax:973-629-1431
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB088933002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY092BE1Medicare ID - Type Unspecified