1972524759 NPI number — MELISSA WEINTRAUB MD

Table of content: MELISSA WEINTRAUB MD (NPI 1972524759)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972524759 NPI number — MELISSA WEINTRAUB MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEINTRAUB
Provider First Name:
MELISSA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1972524759
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 S BEDFORD RD
Provider Second Line Business Mailing Address:
CAREMOUNT MEDICAL, PC
Provider Business Mailing Address City Name:
MOUNT KISCO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10549-3446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-241-1050
Provider Business Mailing Address Fax Number:
914-455-2980

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
360 N BEDFORD RD
Provider Second Line Business Practice Location Address:
CAREMOUNT MEDICAL, PC
Provider Business Practice Location Address City Name:
MOUNT KISCO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10549-1143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-302-8060
Provider Business Practice Location Address Fax Number:
914-455-2980
Provider Enumeration Date:
07/21/2006

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: 207P00000X , with the licence number:  198305 , 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: 796338 . This is a "MVP HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01717835 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060816000002 . This is a "FIDELIS CARE OF NY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5C4632 . This is a "HEALTHNET PIN #" identifier . This identifiers is of the category "OTHER".
  • Identifier: P3680133 . This is a "OXFORD HEALTH PLAN PIN#" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1253030 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2406Q1 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5127457 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10037134 . This is a "CDPHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 796338 . This is a "MVP" identifier . This identifiers is of the category "OTHER".




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