1154659548 NPI number — SUE JANET WEISS-FRIEDLAND PT

Table of content: SUE JANET WEISS-FRIEDLAND PT (NPI 1154659548)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154659548 NPI number — SUE JANET WEISS-FRIEDLAND PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEISS-FRIEDLAND
Provider First Name:
SUE
Provider Middle Name:
JANET
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHERBER
Provider Other First Name:
SUE
Provider Other Middle Name:
JANET
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1154659548
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2222 SULLIVAN TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EASTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18040-7958
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-944-9782
Provider Business Mailing Address Fax Number:
610-438-2024

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4201 SPRINGTREE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUNRISE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33351-6163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-572-4261
Provider Business Practice Location Address Fax Number:
954-572-2603
Provider Enumeration Date:
11/24/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT2719 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)