1134112030 NPI number — DR. GARY M WEINER O.D.

Table of content: DR. GARY M WEINER O.D. (NPI 1134112030)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134112030 NPI number — DR. GARY M WEINER O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEINER
Provider First Name:
GARY
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.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:
1134112030
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
969 MAIN ST
Provider Second Line Business Mailing Address:
SUITE H
Provider Business Mailing Address City Name:
FISHKILL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12524-1789
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-896-6700
Provider Business Mailing Address Fax Number:
845-896-6882

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
969 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
FISHKILL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12524-1789
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-896-6700
Provider Business Practice Location Address Fax Number:
845-896-6882
Provider Enumeration Date:
08/25/2005

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: 152W00000X , with the licence number:  TV 2918 , 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: 10038543 . This is a "C D P H P" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0000470751001 . This is a "HEALTHNOW OF NY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 410033090 . This is a "PALMETTO GBA RR MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P835138 . This is a "OXFORD HEALTH INS." identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4C1784 . This is a "HEALTHNET OF NY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 539306 . This is a "AETNA HEALTH INSURANCE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 597117 . This is a "M V P HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 161526023 . This is a "UNITEDHEALTH THE EMPIRE P" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 161526023 . This is a "POMCO" identifier . This identifiers is of the category "OTHER".
  • Identifier: C951010 . This is a "EMPIRE B/C B/S" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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