Provider Demographics
NPI:1457369753
Name:CLARIDGE-WEISSE, JOANETTE IRENE (MD)
Entity Type:Individual
Prefix:MRS
First Name:JOANETTE
Middle Name:IRENE
Last Name:CLARIDGE-WEISSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:JOANETTE
Other - Middle Name:IRENE
Other - Last Name:HEINRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:56 RING ROAD
Mailing Address - Street 2:
Mailing Address - City:SALT POINT
Mailing Address - State:NY
Mailing Address - Zip Code:12578
Mailing Address - Country:US
Mailing Address - Phone:845-266-5726
Mailing Address - Fax:
Practice Address - Street 1:56 RING ROAD
Practice Address - Street 2:
Practice Address - City:SALT POINT
Practice Address - State:NY
Practice Address - Zip Code:12578
Practice Address - Country:US
Practice Address - Phone:845-266-5726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206639207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
03B671Medicare ID - Type Unspecified
NYG71698Medicare UPIN