Provider Demographics
NPI:1023136371
Name:WEISMAN, GARY HAROLD (DC)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:HAROLD
Last Name:WEISMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:493 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1061
Mailing Address - Country:US
Mailing Address - Phone:973-564-7676
Mailing Address - Fax:973-379-6888
Practice Address - Street 1:493 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1061
Practice Address - Country:US
Practice Address - Phone:973-564-7676
Practice Address - Fax:973-379-6888
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00335400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT88160Medicare UPIN