Provider Demographics
NPI:1114069671
Name:WISSER, JAMIE ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:ROBERT
Last Name:WISSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300B PRINCETON HIGHTSTOWN RD
Mailing Address - Street 2:STE 101
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520
Mailing Address - Country:US
Mailing Address - Phone:609-448-4000
Mailing Address - Fax:609-426-6995
Practice Address - Street 1:300B PRINCETON HIGHTSTOWN RD
Practice Address - Street 2:STE 101
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520
Practice Address - Country:US
Practice Address - Phone:609-448-4000
Practice Address - Fax:609-426-6995
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA05948208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJWI767834Medicare ID - Type Unspecified
E47980Medicare UPIN