Provider Demographics
NPI:1356534648
Name:WEISSMAN, ROSE (APN, C)
Entity type:Individual
Prefix:MS
First Name:ROSE
Middle Name:
Last Name:WEISSMAN
Suffix:
Gender:F
Credentials:APN, C
Other - Prefix:MS
Other - First Name:ROSE
Other - Middle Name:
Other - Last Name:TRAYNOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN - BC
Mailing Address - Street 1:14549 SONOMA BLVD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34114-8658
Mailing Address - Country:US
Mailing Address - Phone:732-796-5722
Mailing Address - Fax:
Practice Address - Street 1:382 LAKE SURPRISE RD
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:NY
Practice Address - Zip Code:10516-4006
Practice Address - Country:US
Practice Address - Phone:732-796-5722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP00165700363LF0000X
NJ26NJ00040900363LF0000X
NY332397-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ079334XVAMedicare UPIN
EO9671Medicare UPIN