Provider Demographics
NPI:1720316086
Name:WEISER, LORI GAIL (MD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:GAIL
Last Name:WEISER
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 1:385 S MAPLE AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-1543
Mailing Address - Country:US
Mailing Address - Phone:201-447-3880
Mailing Address - Fax:
Practice Address - Street 1:385 S MAPLE AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-1543
Practice Address - Country:US
Practice Address - Phone:201-447-3880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-25
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214656207X00000X
NJ25MA08668400207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH95234Medicare UPIN