Provider Demographics
NPI:1003806290
Name:WEINSTOCK, DAVID L (MD,FACC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:WEINSTOCK
Suffix:
Gender:M
Credentials:MD,FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-3243
Mailing Address - Country:US
Mailing Address - Phone:516-596-6100
Mailing Address - Fax:516-599-6989
Practice Address - Street 1:253 BROADWAY
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-3243
Practice Address - Country:US
Practice Address - Phone:516-596-6100
Practice Address - Fax:516-599-6989
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY157422174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01073481Medicaid
NY01073481Medicaid
NYA61169Medicare UPIN