Healthcare Provider Details

I. General information

NPI: 1265471437
Provider Name (Legal Business Name): DAVID RUSSELL WEESNER AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 NEW RD SUITE 301
LINWOOD NJ
08221-1299
US

IV. Provider business mailing address

222 NEW RD SUITE 301
LINWOOD NJ
08221-1299
US

V. Phone/Fax

Practice location:
  • Phone: 609-926-0700
  • Fax: 609-926-4870
Mailing address:
  • Phone: 609-926-0700
  • Fax: 609-926-4870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number41YA00026400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: