Basic Information
Provider Information
NPI: 1487648218
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WEBER
FirstName: BARRY
MiddleName: J
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 419430
Address2:  
City: BOSTON
State: MA
PostalCode: 022419430
CountryCode: US
TelephoneNumber: 2019678221
FaxNumber: 2014832242
Practice Location
Address1: 311 BAY AVE
Address2: MMG PULMONOLOGY
City: GLEN RIDGE
State: NJ
PostalCode: 07028
CountryCode: US
TelephoneNumber: 9737467474
FaxNumber: 9737430265
Other Information
ProviderEnumerationDate: 09/08/2005
LastUpdateDate: 06/30/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/30/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RP1001X24140NJY Allopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease

ID Information
IDTypeStateIssuerDescription
102853801NJHORIZON NJ HEALTHOTHER
22194373601NJUNITED HEALTHCAREOTHER
52610101NJAETNAOTHER
00059651201NJAPWU HEALTH PLANOTHER
100820005NJ MEDICAID
7133701NJEMPIRE BLUEOTHER
22194373601NJTHE MAIL HANDLERS BENEFITOTHER
22194373601NJHORIZON BLUE SHIELDOTHER
102853801NJMERCY HEALTHOTHER
22194373601NJQUALCAREOTHER
22194373601NJPRIVATE HEALTHCARE SYSTEMOTHER
221943736-00401NJST BARNABAS HEALTH PLANOTHER
55153301NJAMERIHEALTHOTHER
CF176701NJRAIL ROAD MEDICAREOTHER
P41687001NJOXFORDOTHER
023249-101NJUNIVERSITY HEALTH PLANOTHER
587933501NJCIGNAOTHER
F0104501NJHEALTHNETOTHER


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