1023256690 NPI number — MARK H. WEINSTEIN, MD PC

Table of content: (NPI 1023256690)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023256690 NPI number — MARK H. WEINSTEIN, MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARK H. WEINSTEIN, MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1023256690
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
136 SHERMAN AVE
Provider Second Line Business Mailing Address:
407
Provider Business Mailing Address City Name:
NEW HAVEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06511-5238
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-624-0673
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
136 SHERMAN AVE
Provider Second Line Business Practice Location Address:
407
Provider Business Practice Location Address City Name:
NEW HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06511-5238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-624-0673
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/04/2009

Additional Information

Authorized Official

Authorized Official Last Name:
WEINSTEIN
Authorized Official First Name:
MARK
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
203-624-0673

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  018620 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 010018620CT01 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001186204 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 020021073 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 240000035 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0Q0135 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 186200 . This is a "CTCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: NHS110 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".




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