Provider Demographics
NPI:1184618373
Name:WEEMS, LELA (MD)
Entity type:Individual
Prefix:DR
First Name:LELA
Middle Name:
Last Name:WEEMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 PLYMOUTH ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2137
Mailing Address - Country:US
Mailing Address - Phone:917-572-2880
Mailing Address - Fax:973-337-8219
Practice Address - Street 1:80 PLYMOUTH ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2137
Practice Address - Country:US
Practice Address - Phone:917-572-2880
Practice Address - Fax:973-337-8219
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2009-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229333-1207L00000X
NJ25MA08529200207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02472517Medicaid
NYH81380Medicare UPIN
NY02472517Medicaid