Healthcare Provider Details

I. General information

NPI: 1033190103
Provider Name (Legal Business Name): HOWARD WEIZMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 10/31/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KALISA WAY SUITE 210
PARAMUS NJ
07652
US

IV. Provider business mailing address

1 KALISA WAY SUITE 210
PARAMUS NJ
07652
US

V. Phone/Fax

Practice location:
  • Phone: 201-447-0013
  • Fax: 201-255-4515
Mailing address:
  • Phone: 201-447-0013
  • Fax: 201-255-4515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number25MA04968300
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: