Provider Demographics
NPI:1023195377
Name:WEINSAFT, MALCOLM HOWARD (MD)
Entity Type:Individual
Prefix:
First Name:MALCOLM
Middle Name:HOWARD
Last Name:WEINSAFT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 E 9TH ST
Mailing Address - Street 2:SUITE 1-E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-6311
Mailing Address - Country:US
Mailing Address - Phone:212-979-6028
Mailing Address - Fax:212-979-6028
Practice Address - Street 1:55 E 9TH ST
Practice Address - Street 2:SUITE 1-E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-6311
Practice Address - Country:US
Practice Address - Phone:212-979-6028
Practice Address - Fax:212-979-6028
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY092302207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00307740Medicaid
NY00307740Medicaid