Provider Demographics
NPI:1073615225
Name:WEINBERG, JED JACOB (MD)
Entity Type:Individual
Prefix:
First Name:JED
Middle Name:JACOB
Last Name:WEINBERG
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 1:200 WEST CARVER ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743
Mailing Address - Country:US
Mailing Address - Phone:631-421-0020
Mailing Address - Fax:631-421-5139
Practice Address - Street 1:200 WEST CARVER ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743
Practice Address - Country:US
Practice Address - Phone:631-421-0020
Practice Address - Fax:631-421-5139
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156336207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
393738OtherCONNECTICARE
JW097D9410OtherBLUE CROSS BLUE SHIELD
Y046026OtherCHAMPUS
NY01022119Medicaid
1039200OtherUNITED
1563380OtherWCNF
110052245OtherRRMC
CP682OtherOXFORD
WJ6336OtherATLANTIS
168336OtherHIP
4231330OtherAETNA
112234962OtherCIGNA
OC8734OtherHEALTHNET
OC8734OtherCARECORE
080OtherNY MEDICAID
18984OtherVYTRA
3011OtherNEIC
3011OtherNEIC
JW097D9410OtherBLUE CROSS BLUE SHIELD
WJ6336OtherATLANTIS