1457622276 NPI number — LEE WEINER, DC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457622276 NPI number — LEE WEINER, DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEE WEINER, DC
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:
1457622276
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9A DAVISON AVE W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCEANSIDE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11572-2132
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-255-0272
Provider Business Mailing Address Fax Number:
516-255-9130

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9A DAVISON AVE W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCEANSIDE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11572-2132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-255-0272
Provider Business Practice Location Address Fax Number:
516-255-9130
Provider Enumeration Date:
01/25/2012

Additional Information

Authorized Official

Authorized Official Last Name:
WEINER
Authorized Official First Name:
LEE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
516-255-0272

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  X09660 , 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: X4E051 . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".




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