Healthcare Provider Details

I. General information

NPI: 1801065016
Provider Name (Legal Business Name): ROGER ALLEN WEISS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BAMBOO LANE
FAR HILLS NJ
07931
US

IV. Provider business mailing address

1 BAMBOO LANE
FAR HILLS NJ
07931
US

V. Phone/Fax

Practice location:
  • Phone: 917-328-9274
  • Fax: 908-470-0712
Mailing address:
  • Phone: 917-328-9274
  • Fax: 908-470-0712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX0042581
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberNYSIMEC042582B
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: