1013244185 NPI number — RICHARD B WEININGER M.D.

Table of content: RICHARD B WEININGER M.D. (NPI 1013244185)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013244185 NPI number — RICHARD B WEININGER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEININGER
Provider First Name:
RICHARD
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013244185
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O BOX 737
Provider Second Line Business Mailing Address:
125 MILLBROOK RD.
Provider Business Mailing Address City Name:
CLAVERACK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-388-0800
Provider Business Mailing Address Fax Number:
518-751-1531

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 MILLBROOK ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUDSON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-388-0800
Provider Business Practice Location Address Fax Number:
518-751-1531
Provider Enumeration Date:
11/11/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  117078 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 117078 . This is a "STATE LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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