Provider Demographics
NPI:1265511752
Name:WEINSTEIN, LEON
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:
Last Name:WEINSTEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10837 71ST AVE
Mailing Address - Street 2:UNIT PO2
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4566
Mailing Address - Country:US
Mailing Address - Phone:718-575-8787
Mailing Address - Fax:718-575-8789
Practice Address - Street 1:10837 71ST AVE
Practice Address - Street 2:UNIT PO2
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4566
Practice Address - Country:US
Practice Address - Phone:718-575-8787
Practice Address - Fax:718-575-8789
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195673207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F86523Medicare UPIN