Provider Demographics
NPI:1336359736
Name:WEISSMAN, LOIS (MS, NP)
Entity Type:Individual
Prefix:MS
First Name:LOIS
Middle Name:
Last Name:WEISSMAN
Suffix:
Gender:F
Credentials:MS, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 POND TER
Mailing Address - Street 2:
Mailing Address - City:TOWNSHIP OF WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07676-5121
Mailing Address - Country:US
Mailing Address - Phone:201-403-0504
Mailing Address - Fax:973-972-2559
Practice Address - Street 1:703 MAIN ST
Practice Address - Street 2:R3S ROOM 3073
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-2621
Practice Address - Country:US
Practice Address - Phone:973-754-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN103533363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NN103533OtherNJ LICENSE