Provider Demographics
NPI:1093234668
Name:WEIL, BENJAMIN SAMUEL (RDN, RD, CDN)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:SAMUEL
Last Name:WEIL
Suffix:
Gender:M
Credentials:RDN, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 BAYSWATER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-1730
Mailing Address - Country:US
Mailing Address - Phone:718-249-6027
Mailing Address - Fax:
Practice Address - Street 1:2930 BAYSWATER AVE FL 2
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-1730
Practice Address - Country:US
Practice Address - Phone:718-249-6027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-14
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008805-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered