Provider Demographics
NPI:1295743912
Name:WEINER, MONICA B (MD)
Entity type:Individual
Prefix:DR
First Name:MONICA
Middle Name:B
Last Name:WEINER
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:PO BOX 635
Mailing Address - Street 2:
Mailing Address - City:BELLMAWR
Mailing Address - State:NJ
Mailing Address - Zip Code:08099-0635
Mailing Address - Country:US
Mailing Address - Phone:856-770-5772
Mailing Address - Fax:856-566-2797
Practice Address - Street 1:42 E LAUREL RD
Practice Address - Street 2:UDP 1100
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1354
Practice Address - Country:US
Practice Address - Phone:856-566-7036
Practice Address - Fax:856-566-6108
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA08084200208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0115401Medicaid