Provider Demographics
NPI:1053507335
Name:BARRY E. WEINER, DPM INC
Entity Type:Organization
Organization Name:BARRY E. WEINER, DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-454-3668
Mailing Address - Street 1:3939 J ST STE 270
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3666
Mailing Address - Country:US
Mailing Address - Phone:916-454-3668
Mailing Address - Fax:916-454-9255
Practice Address - Street 1:3939 J ST STE 270
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3666
Practice Address - Country:US
Practice Address - Phone:916-454-3668
Practice Address - Fax:916-454-9255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2459213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E24590Medicaid
CA000E24590Medicare PIN
CAT11340Medicare UPIN
CA000E24590Medicaid