Individual
LESLIE J WEISS-BLOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
100 PROSPECT AVE, #4F, HACKENSACK, NJ 07601-1910
(201) 487-8557
Mailing address
44 NELSON PL, TENAFLY, NJ 07670-1215
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MA58175
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5658004
—
NJ
Enumeration date
11/20/2006
Last updated
07/08/2007
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