Provider Demographics
NPI:1982643458
Name:WEISS, MITCHELL F (MD)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:F
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020A E BOAL AVE
Mailing Address - Street 2:
Mailing Address - City:BOALSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16827-1509
Mailing Address - Country:US
Mailing Address - Phone:814-237-8627
Mailing Address - Fax:814-238-0083
Practice Address - Street 1:300 2ND AVE
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-6303
Practice Address - Country:US
Practice Address - Phone:732-923-6890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA075875002085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223522719OtherHORIZON BCBS
NJ35846OtherUNIVERSITY HEALTH PLAN
NJ60018017OtherHORIZON NJ HEALTH
NJP3241104OtherOXFORD
NJ01000598001OtherAMERICHOICE
NJ2317E1OtherWELL CHOICE
NJ7398492OtherAETNA PPO
NJ0068870Medicaid
NJ2277560000OtherAMERIHEALTH
NJ314151OtherUS FAMILY HEALTH PLAN
NJ8219832OtherGHI
NJ8331983OtherCIGNA
NJ199577OtherAMERIGROUP
NJ3371544OtherAETNA HMO
NJ2K6840OtherHEALTHNET
NJ223522719OtherUNITED HEALTHCARE
NJ2277560000OtherAMERIHEALTH
NJ60018017OtherHORIZON NJ HEALTH
NJ076450Medicare ID - Type Unspecified