Healthcare Provider Details

I. General information

NPI: 1306028857
Provider Name (Legal Business Name): JOSHUA A WEIDMAN MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 03/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 FRANKLIN AVENUE, SUITE 5
FRANKLIN LAKES NJ
07417
US

IV. Provider business mailing address

841 FRANKLIN AVE SUITE #5
FRANKLIN LAKES NJ
07417-1418
US

V. Phone/Fax

Practice location:
  • Phone: 201-891-8811
  • Fax:
Mailing address:
  • Phone: 201-891-8811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA05252000
License Number StateNJ

VIII. Authorized Official

Name: DR. JOSHUA A WEIDMAN
Title or Position: MANAGER
Credential: M.D.
Phone: 201-891-8811