Provider Demographics
NPI:1437222650
Name:MITCHELL I. WEINSTEIN, D.O., P.C.
Entity Type:Organization
Organization Name:MITCHELL I. WEINSTEIN, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:IRA
Authorized Official - Last Name:WEINSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-321-3840
Mailing Address - Street 1:631 MONTAUK HWY STE 2
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4400
Mailing Address - Country:US
Mailing Address - Phone:631-321-3840
Mailing Address - Fax:631-321-3842
Practice Address - Street 1:631 MONTAUK HWY STE 2
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4400
Practice Address - Country:US
Practice Address - Phone:631-321-3840
Practice Address - Fax:631-321-3842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162637-1207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01416811Medicaid
NYE20437Medicare UPIN
NY23F83NW081Medicare ID - Type UnspecifiedINDIVIDUAL #