Provider Demographics
NPI:1932499191
Name:JOSEF M. WEISGRAS MD PA
Entity Type:Organization
Organization Name:JOSEF M. WEISGRAS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEF
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEISGRAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-384-0036
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-0640
Mailing Address - Country:US
Mailing Address - Phone:973-759-8700
Mailing Address - Fax:973-759-7545
Practice Address - Street 1:375 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-4323
Practice Address - Country:US
Practice Address - Phone:201-384-0036
Practice Address - Fax:201-384-7304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0068098Medicaid
NJ0068098Medicaid