Provider Demographics
NPI:1457328346
Name:WEINSTOCK, GARY ALAN (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:ALAN
Last Name:WEINSTOCK
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 1:1000 NORTHERN BLVD
Mailing Address - Street 2:STE 250
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5341
Mailing Address - Country:US
Mailing Address - Phone:516-487-1073
Mailing Address - Fax:516-487-6751
Practice Address - Street 1:1000 NORTHERN BLVD
Practice Address - Street 2:STE 250
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5341
Practice Address - Country:US
Practice Address - Phone:516-487-1073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2017-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142638207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B20729Medicare UPIN
B20729Medicare UPIN