Provider Demographics
NPI:1225131550
Name:WEINTRAUB, FREDERICK M (DPM)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:M
Last Name:WEINTRAUB
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 PARIS AVE STE A
Mailing Address - Street 2:
Mailing Address - City:NORTHVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07647-2054
Mailing Address - Country:US
Mailing Address - Phone:201-784-1828
Mailing Address - Fax:201-784-1611
Practice Address - Street 1:153 PARIS AVE
Practice Address - Street 2:STE A
Practice Address - City:NORTHVALE
Practice Address - State:NJ
Practice Address - Zip Code:07647-2053
Practice Address - Country:US
Practice Address - Phone:201-784-1828
Practice Address - Fax:201-784-1611
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00178500213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ133395790OtherUNITED HEALTHCARE
NJ133395790OtherUNITED HEALTHCARE