Provider Demographics
NPI:1477554426
Name:WEININGER, DAVID (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:WEININGER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 EASTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1719
Mailing Address - Country:US
Mailing Address - Phone:732-545-6035
Mailing Address - Fax:732-249-6952
Practice Address - Street 1:177 EASTON AVE
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1719
Practice Address - Country:US
Practice Address - Phone:732-545-6035
Practice Address - Fax:732-249-6952
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3854152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1962001Medicaid
NJ40848OtherAETNA
NJ0141520001Medicare NSC
NJ1962001Medicaid
NJU17461Medicare UPIN