Provider Demographics
NPI:1467421081
Name:WEINTRAUB, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:WEINTRAUB
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 1:325 S HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BRIARCLIFF MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10510-2096
Mailing Address - Country:US
Mailing Address - Phone:914-941-0788
Mailing Address - Fax:914-941-0562
Practice Address - Street 1:325 S HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:BRIARCLIFF MANOR
Practice Address - State:NY
Practice Address - Zip Code:10510-2096
Practice Address - Country:US
Practice Address - Phone:914-941-0788
Practice Address - Fax:914-941-0562
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY098861-12084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00714269Medicaid
NY098861-1Medicare ID - Type Unspecified
NYB20368Medicare UPIN