Provider Demographics
NPI:1225113723
Name:MARTIN N WEINER, MD PA
Entity Type:Organization
Organization Name:MARTIN N WEINER, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:N
Authorized Official - Last Name:WEINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-796-5352
Mailing Address - Street 1:4-14 SADDLE RIVER RD
Mailing Address - Street 2:SUITE #203
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-5632
Mailing Address - Country:US
Mailing Address - Phone:201-796-5352
Mailing Address - Fax:201-797-6089
Practice Address - Street 1:4-14 SADDLE RIVER RD
Practice Address - Street 2:SUITE #203
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-5632
Practice Address - Country:US
Practice Address - Phone:201-796-5352
Practice Address - Fax:201-797-6089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA288762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2792800Medicaid
NJ2792800Medicaid
NJ113704Medicare ID - Type UnspecifiedMEDICARE