Provider Demographics
NPI:1164539524
Name:WEIDENMAN, DARREN J (PT, MA)
Entity Type:Individual
Prefix:MR
First Name:DARREN
Middle Name:J
Last Name:WEIDENMAN
Suffix:
Gender:M
Credentials:PT, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:713 WALT WHITMAN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2202
Mailing Address - Country:US
Mailing Address - Phone:631-425-5900
Mailing Address - Fax:631-424-9850
Practice Address - Street 1:713 WALT WHITMAN RD
Practice Address - Street 2:SUITE B
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-2202
Practice Address - Country:US
Practice Address - Phone:631-425-5900
Practice Address - Fax:631-424-9850
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015673-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQK6201Medicare ID - Type Unspecified