Provider Demographics
NPI:1023372158
Name:LEE WEINER
Entity Type:Organization
Organization Name:LEE WEINER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-280-7180
Mailing Address - Street 1:320 POST AVE
Mailing Address - Street 2:100
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-2257
Mailing Address - Country:US
Mailing Address - Phone:516-280-7180
Mailing Address - Fax:
Practice Address - Street 1:320 POST AVE
Practice Address - Street 2:100
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-2257
Practice Address - Country:US
Practice Address - Phone:516-280-7180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-04
Last Update Date:2012-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX4E051332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6657230001OtherPTAN
NYX4E051OtherMEDCIARE PTAN