Provider Demographics
NPI:1417998659
Name:WEINSTEIN, BERNARD LARRY (MD)
Entity Type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:LARRY
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:MAALEH OREN 12, P.O. BOX 1182
Mailing Address - Street 2:
Mailing Address - City:EFRAT
Mailing Address - State:NONE
Mailing Address - Zip Code:90435
Mailing Address - Country:IL
Mailing Address - Phone:9722-993-3686
Mailing Address - Fax:
Practice Address - Street 1:4021 S 700 E
Practice Address - Street 2:SUITE 300
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2192
Practice Address - Country:US
Practice Address - Phone:800-328-3035
Practice Address - Fax:801-284-6810
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA073510002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E87515Medicare UPIN