Provider Demographics
NPI:1255460382
Name:WEISBAND, I. DAVID (DO)
Entity type:Individual
Prefix:
First Name:I. DAVID
Middle Name:
Last Name:WEISBAND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 COX RD
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3939
Mailing Address - Country:US
Mailing Address - Phone:856-778-0544
Mailing Address - Fax:856-778-5906
Practice Address - Street 1:875 COX RD
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3939
Practice Address - Country:US
Practice Address - Phone:856-778-0544
Practice Address - Fax:856-778-5906
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB02607600207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC58074Medicare UPIN
NJ171539Medicare ID - Type Unspecified