Healthcare Provider Details

I. General information

NPI: 1336485333
Provider Name (Legal Business Name): WEISS, HUMANICK SUPPORT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2012
Last Update Date: 12/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 STRYKERS CROSSING SUITE 19-187
LAPATACONG NJ
08865
US

IV. Provider business mailing address

201 STRYKERS CROSSING SUITE 19-187
LAPATACONG NJ
08865
US

V. Phone/Fax

Practice location:
  • Phone: 570-242-2010
  • Fax:
Mailing address:
  • Phone: 570-242-2010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DANIELLE MARIE WEISS
Title or Position: OWNER
Credential:
Phone: 570-242-2010