Provider Demographics
NPI:1295789170
Name:BLEIWEISS, ROBERT SCOTT (PA-C)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:SCOTT
Last Name:BLEIWEISS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 POMPTON AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-1820
Mailing Address - Country:US
Mailing Address - Phone:973-239-2300
Mailing Address - Fax:
Practice Address - Street 1:480 POMPTON AVE STE 6
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-1820
Practice Address - Country:US
Practice Address - Phone:973-239-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00086000363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT32103Medicare UPIN