Healthcare Provider Details

I. General information

NPI: 1437253051
Provider Name (Legal Business Name): JEFFREY S WEISER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 SOUTH RD STE 100
FARMINGTON CT
06032-2482
US

IV. Provider business mailing address

30 WATERCHASE DR
ROCKY HILL CT
06067-2110
US

V. Phone/Fax

Practice location:
  • Phone: 860-409-4567
  • Fax: 860-409-4846
Mailing address:
  • Phone: 860-257-4131
  • Fax: 860-257-4519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number035977
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: