Basic Information
| Provider Information | |||||||||
| NPI: | 1982643458 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEISS | ||||||||
| FirstName: | MITCHELL | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1020A E BOAL AVE | ||||||||
| Address2: | |||||||||
| City: | BOALSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 168271509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142378627 | ||||||||
| FaxNumber: | 8142380083 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 2ND AVE | ||||||||
| Address2: | |||||||||
| City: | LONG BRANCH | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077406303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7329236890 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 01/05/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 25MA07587500 | NJ | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 223522719 | 01 | NJ | HORIZON BCBS | OTHER | 35846 | 01 | NJ | UNIVERSITY HEALTH PLAN | OTHER | 60018017 | 01 | NJ | HORIZON NJ HEALTH | OTHER | P3241104 | 01 | NJ | OXFORD | OTHER | 01000598001 | 01 | NJ | AMERICHOICE | OTHER | 2317E1 | 01 | NJ | WELL CHOICE | OTHER | 7398492 | 01 | NJ | AETNA PPO | OTHER | 0068870 | 05 | NJ | MEDICAID | 2277560000 | 01 | NJ | AMERIHEALTH | OTHER | 314151 | 01 | NJ | US FAMILY HEALTH PLAN | OTHER | 8219832 | 01 | NJ | GHI | OTHER | 8331983 | 01 | NJ | CIGNA | OTHER | 199577 | 01 | NJ | AMERIGROUP | OTHER | 3371544 | 01 | NJ | AETNA HMO | OTHER | 2K6840 | 01 | NJ | HEALTHNET | OTHER | 223522719 | 01 | NJ | UNITED HEALTHCARE | OTHER |