Healthcare Provider Details

I. General information

NPI: 1003924903
Provider Name (Legal Business Name): LYNNE WEISS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 FRENCH STREET SUITE 2300
NEW BRUNSWICK NJ
08901
US

IV. Provider business mailing address

66 WEST GILBERT
RED BANK NJ
07701
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-6230
  • Fax: 732-235-6620
Mailing address:
  • Phone: 732-212-0051
  • Fax: 732-212-0713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number25MA036393
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: