Provider Demographics
NPI:1083617518
Name:WEINRAUB, SARTON BRODIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SARTON
Middle Name:BRODIE
Last Name:WEINRAUB
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 E 9TH ST
Mailing Address - Street 2:APT 6
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-4938
Mailing Address - Country:US
Mailing Address - Phone:212-673-8790
Mailing Address - Fax:212-208-2955
Practice Address - Street 1:439 E 9TH ST
Practice Address - Street 2:APT 6
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-4938
Practice Address - Country:US
Practice Address - Phone:212-673-8790
Practice Address - Fax:212-208-2955
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016243103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP3587857OtherOXFORD HEALTH PLANS
NY02637281Medicaid
NYV732L1Medicare ID - Type Unspecified