Physician Compare National (NPI:1164540019)

HEALTHCARE PROVIDER: FREDERICK J WEISBROT MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1164540019
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7719017516
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100604000432
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WEISBROT
	Individual professional last name
Provider First Name	FREDERICK
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	MEDICAL COLLEGE OF WISCONSIN
	Individual professional's medical school
Graduation Year	1973
	Individual professional's medical school graduation year
Primary Specialty	PSYCHIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	NEUROLOGY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	NEUROLOGY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	CENTRAL AVENUE PROFESSIONAL SERVICES, PC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	7214258003
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	30
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	111 CENTRAL AVE
	Group Practice or individual's line 1 address
City	NEWARK
	Group Practice or individual's city
State	NJ
	Group Practice or individual's state
Zip Code	071021909
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y