Provider Demographics
NPI:1134112030
Name:WEINER, GARY M (OD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:M
Last Name:WEINER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:969 MAIN ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-1789
Mailing Address - Country:US
Mailing Address - Phone:845-896-6700
Mailing Address - Fax:845-896-6882
Practice Address - Street 1:969 MAIN ST
Practice Address - Street 2:SUITE H
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-1789
Practice Address - Country:US
Practice Address - Phone:845-896-6700
Practice Address - Fax:845-896-6882
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTV 2918152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10038543OtherC D P H P
NY0000470751001OtherHEALTHNOW OF NY
NY410033090OtherPALMETTO GBA RR MEDICARE
NYP835138OtherOXFORD HEALTH INS.
NY4C1784OtherHEALTHNET OF NY
NY539306OtherAETNA HEALTH INSURANCE
NY597117OtherM V P HEALTH PLAN
NY161526023OtherUNITEDHEALTH THE EMPIRE P
161526023OtherPOMCO
NYC951010OtherEMPIRE B/C B/S
NYT49186Medicare UPIN
NY1166630001Medicare NSC
NYC951010Medicare PIN