Provider Demographics
NPI:1063536555
Name:EDWARD C WEISS MD PA
Entity type:Organization
Organization Name:EDWARD C WEISS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:CONROD
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-731-8050
Mailing Address - Street 1:95 NORTHFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-4723
Mailing Address - Country:US
Mailing Address - Phone:973-731-8050
Mailing Address - Fax:973-731-8270
Practice Address - Street 1:95 NORTHFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-4723
Practice Address - Country:US
Practice Address - Phone:973-731-8050
Practice Address - Fax:973-731-8270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA01963200207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2625903Medicaid
0553270001Medicare NSC
C52721Medicare UPIN
NJ2625903Medicaid