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General NPI Number Information
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NPI Number | 1396248894
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Entity Type | Organization
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Legal Business Name | DR. TAMARA WEISMAN, LLC
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Dates
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Enumeration Date | 03/12/2018
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Last Update Date | 03/12/2018
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Provider Practice Location Address
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Address Line | 14 RIDGEDALE AVE STE 103
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City | CEDAR KNOLLS
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State | NJ
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Zip | 07927-1106
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Country | US
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Telephone | 973-998-6181
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Fax | 973-629-1431
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Provider Business Mailing Address
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Address Line | 142 HILLSIDE AVE
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City | LIVINGSTON
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State | NJ
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Zip | 07039-2846
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Country | US
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Telephone | 973-998-6181
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TAMARA WEISMAN
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Credential | DO
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Telephone | 973-998-6181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 25MB08893300
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License Number State | NJ
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