Provider Demographics
NPI:1366516684
Name:HOWARD JAY WEISMAN MD PC
Entity type:Organization
Organization Name:HOWARD JAY WEISMAN MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEISMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-333-8520
Mailing Address - Street 1:1950 GEARY RD
Mailing Address - Street 2:HOWARD WEISMAN MD PC
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523
Mailing Address - Country:US
Mailing Address - Phone:510-333-8520
Mailing Address - Fax:925-287-9011
Practice Address - Street 1:1950 GEARY RD
Practice Address - Street 2:HOWARD WEISMAN MD PC
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523
Practice Address - Country:US
Practice Address - Phone:510-333-8520
Practice Address - Fax:925-287-9011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0005042Medicare ID - Type Unspecified
D46849Medicare UPIN