Provider Demographics
NPI:1346293420
Name:WEINBERG, JERRY J (MD)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:J
Last Name:WEINBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:666 LEXINGTON AVENUE
Mailing Address - Street 2:STE 100
Mailing Address - City:MT. KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3637
Mailing Address - Country:US
Mailing Address - Phone:914-666-4346
Mailing Address - Fax:914-666-5848
Practice Address - Street 1:666 LEXINGTON AVENUE
Practice Address - Street 2:STE 100
Practice Address - City:MT. KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3637
Practice Address - Country:US
Practice Address - Phone:914-666-4346
Practice Address - Fax:914-666-5848
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY159368208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY17F87WS371OtherRAILROAD MEDICARE
E17172Medicare UPIN
NY17F871Medicare PIN