Provider Demographics
NPI:1467407783
Name:WEINBERGER, JESSICA (FNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:WEINBERGER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 STATION PLZ N
Mailing Address - Street 2:SUITE 518
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3800
Mailing Address - Country:US
Mailing Address - Phone:516-663-2588
Mailing Address - Fax:516-663-4644
Practice Address - Street 1:222 STATION PLZ N
Practice Address - Street 2:SUITE 518
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3800
Practice Address - Country:US
Practice Address - Phone:516-663-2588
Practice Address - Fax:516-663-4644
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY440033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3730393Medicaid
TNQ34758Medicare UPIN