Provider Demographics
NPI:1174750889
Name:WEBER, CYNTHIA E
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:E
Last Name:WEBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 ROUTE 23 STE 180
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-7522
Mailing Address - Country:US
Mailing Address - Phone:800-633-8446
Mailing Address - Fax:414-454-0152
Practice Address - Street 1:1680 ROUTE 23 STE 180
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-7522
Practice Address - Country:US
Practice Address - Phone:800-633-8446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125056615208600000X
NY300793-01208600000X
OH35.133945208600000X
WI66644208600000X
NJ25MA10686400208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1174750889Medicaid