1750617890 NPI number — DR. MARK IAN WEINBERGER PH.D., MPH

Table of content: DR. MARK IAN WEINBERGER PH.D., MPH (NPI 1750617890)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750617890 NPI number — DR. MARK IAN WEINBERGER PH.D., MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEINBERGER
Provider First Name:
MARK
Provider Middle Name:
IAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D., MPH
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:
1750617890
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
660 WHITE PLAINS RD
Provider Second Line Business Mailing Address:
SUITE 630
Provider Business Mailing Address City Name:
TARRYTOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10591-5139
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-323-0345
Provider Business Mailing Address Fax Number:
914-219-3171

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
660 WHITE PLAINS RD
Provider Second Line Business Practice Location Address:
SUITE 630
Provider Business Practice Location Address City Name:
TARRYTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10591-5139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-323-0345
Provider Business Practice Location Address Fax Number:
914-219-3171
Provider Enumeration Date:
10/25/2009

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: 103TC0700X , with the licence number:  018126 , 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)





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