Provider Demographics
NPI:1093038226
Name:WEITZ, JANET
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:WEITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 EAST ROUTE 70
Mailing Address - Street 2:BUILDING 100
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053
Mailing Address - Country:US
Mailing Address - Phone:856-983-3900
Mailing Address - Fax:856-810-0110
Practice Address - Street 1:765 EAST ROUTE 70
Practice Address - Street 2:BUILDING 100
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053
Practice Address - Country:US
Practice Address - Phone:856-983-3900
Practice Address - Fax:856-810-0110
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00281800363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health