Table of content for
JEFFREY
CHARLES
WEINREB
MD (NPI 1548241540)
GeneralOrganization/Personal Information
| Employer Identification Number (EIN) | : | |
| Provider Organization Name (Legal Business Name) | : | |
| Provider Last Name (Legal Name) | : | WEINREB |
| Provider First Name | : | JEFFREY |
| Provider Middle Name | : | CHARLES |
| Provider Name Prefix Text | : | |
| Provider Name Suffix Text | : | |
| Provider Credential Text | : | MD |
| 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 | : | 1548241540 |
| Entity Type Code | : | Individual |
| Replacement NPI | : | |
| Last Update Date | : | 07/08/2007 |
| NPI Deactivation Reason Code | : | |
| NPI Deactivation Date | : | |
| NPI Reactivation Date | : | |
Provider's Business Mailing Address
| Provider First Line Business Mailing Address | : | 300 GEORGE ST |
| Provider Second Line Business Mailing Address | : | 6TH FLOOR |
| Provider Business Mailing Address City Name | : | NEW HAVEN |
| Provider Business Mailing Address State Name | : | CT |
| Provider Business Mailing Address Postal Code | : | 065116624 |
| Provider Business Mailing Address Country Code | : | US |
| Provider Business Mailing Address Telephone Number | : | 2037857998 |
| Provider Business Mailing Address Fax Number | : | 2037856414 |
Provider's Practice Location Mailing Address
| Provider First Line Business Practice Location Address | : | 800 HOWARD AVE |
| Provider Second Line Business Practice Location Address | : | YALE PHYSICIANS BUILDING |
| Provider Business Practice Location Address City Name | : | NEW HAVEN |
| Provider Business Practice Location Address State Name | : | CT |
| Provider Business Practice Location Address Postal Code | : | 065191369 |
| Provider Business Practice Location Address Country Code | : | US |
| Provider Business Practice Location Address Telephone Number | : | 2037852140 |
| Provider Business Practice Location Address Fax Number | : | 2037856414 |
| Provider Enumeration Date | : | 11/08/2005 |
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: 2085R0202X
, with the licence number: 040768
, registered in the state of CT
.
Other Provider's Identifiers (legacy, non-NPI)
- Identifier: A64320
.
This identifiers is of the category "".
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