MEDICARE: DR. GERALD M WEISFOGEL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	25MA03056300	NJ

General Provider Information

NPI Number	:	1063458180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERALD M WEISFOGEL M.D.

Provider Business Mailing Address
First Line	:	2050 RTE 27
Second Line	:	SUITE 205
City	:	NORTH BRUNSWICK
State	:	NJ
Zip	:	08902-1380
Country	:	US
Telephone Number	:	732-821-5511
Fax Number	:	732-821-5347

Provider Business Practice Location Address
First Line	:	3542 STATE ROUTE 27
Second Line	:
City	:	KENDALL PARK
State	:	NJ
Zip	:	08824-1050
Country	:	US
Telephone Number	:	732-821-5562
Fax Number	:	732-821-5347

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	10/21/2020

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