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General NPI Number Information
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NPI Number | 1215495569
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Entity Type | Individual
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Provider Name | SCOTT DOUGLAS WEILAND TCH
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Gender | Male
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Dates
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Enumeration Date | 03/06/2019
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Last Update Date | 03/06/2019
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Provider Practice Location Address
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Address Line | 39 LAKESIDE BLVD
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City | HOPATCONG
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State | NJ
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Zip | 07843-1311
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Country | US
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Telephone | 862-707-8188
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Fax |
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Provider Business Mailing Address
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Address Line | 117 MAIN ST APT 2
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City | ANDOVER
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State | NJ
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Zip | 07821-4578
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Country | US
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Telephone | 973-903-4767
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1120215
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1120216
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License Number State | NJ
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