Provider Demographics
NPI:1972033025
Name:WEIDMAN, JENNA RUTH (MD)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:RUTH
Last Name:WEIDMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:RUTH
Other - Last Name:KASTAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:134 BRIDGETON PIKE STE C
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-2616
Mailing Address - Country:US
Mailing Address - Phone:856-507-2783
Mailing Address - Fax:856-221-4138
Practice Address - Street 1:1238 CHEWS LANDING RD
Practice Address - Street 2:
Practice Address - City:CLEMENTON
Practice Address - State:NJ
Practice Address - Zip Code:08021-2808
Practice Address - Country:US
Practice Address - Phone:856-545-9560
Practice Address - Fax:856-497-5214
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT213856207Q00000X
PAMD470167207Q00000X
NJ25MA12248500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine