Healthcare Provider Details

I. General information

NPI: 1356107601
Provider Name (Legal Business Name): LOLA SKYE WEINSTEIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CAPITAL WAY STE 390
PENNINGTON NJ
08534-2520
US

IV. Provider business mailing address

200 SCHULZ DR STE 2
RED BANK NJ
07701-6745
US

V. Phone/Fax

Practice location:
  • Phone: 732-426-3420
  • Fax:
Mailing address:
  • Phone: 732-333-8720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA065386
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00837000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: