Provider Demographics
NPI:1306839733
Name:WEINSTEIN, LARRY PHILLIP (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:PHILLIP
Last Name:WEINSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 ROUTE 24
Mailing Address - Street 2:SUITE 3K
Mailing Address - City:CHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07930-2918
Mailing Address - Country:US
Mailing Address - Phone:908-879-2222
Mailing Address - Fax:908-879-8993
Practice Address - Street 1:385 ROUTE 24
Practice Address - Street 2:SUITE 3K
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930-2918
Practice Address - Country:US
Practice Address - Phone:908-879-2222
Practice Address - Fax:908-879-8993
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA40682208200000X
NY144771208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0951005Medicaid
NJ0951005Medicaid
NJ550361Medicare ID - Type Unspecified