Provider Demographics
NPI:1396248894
Name:DR. TAMARA WEISMAN, LLC
Entity type:Organization
Organization Name:DR. TAMARA WEISMAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:973-998-6181
Mailing Address - Street 1:142 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-2846
Mailing Address - Country:US
Mailing Address - Phone:973-998-6181
Mailing Address - Fax:
Practice Address - Street 1:14 RIDGEDALE AVE STE 103
Practice Address - Street 2:
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-1106
Practice Address - Country:US
Practice Address - Phone:973-998-6181
Practice Address - Fax:973-629-1431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB088933002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty