Provider Demographics
NPI:1861435828
Name:WEISS, CHERIE HELEN (PA-C)
Entity type:Individual
Prefix:
First Name:CHERIE
Middle Name:HELEN
Last Name:WEISS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 AVENUE AT THE CMN
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4802
Mailing Address - Country:US
Mailing Address - Phone:732-380-0200
Mailing Address - Fax:
Practice Address - Street 1:160 AVENUE AT THE CMN
Practice Address - Street 2:SUITE 1
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4802
Practice Address - Country:US
Practice Address - Phone:732-380-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMP107300363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ076982Medicare PIN
Q16513Medicare UPIN