Healthcare Provider Details

I. General information

NPI: 1851849830
Provider Name (Legal Business Name): JENNIFER WEINER P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 BEAUVOIR AVE FL 5
SUMMIT NJ
07901-3533
US

IV. Provider business mailing address

PO BOX 416457
BOSTON MA
02241-6457
US

V. Phone/Fax

Practice location:
  • Phone: 908-608-0078
  • Fax: 908-608-1504
Mailing address:
  • Phone: 844-362-1735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number020166
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00422900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: