Provider Demographics
NPI:1518906304
Name:WEINBERG, ROBERT JAY (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JAY
Last Name:WEINBERG
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 1:77 HAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-4929
Mailing Address - Country:US
Mailing Address - Phone:631-283-4300
Mailing Address - Fax:631-283-8140
Practice Address - Street 1:77 HAMPTON RD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-4929
Practice Address - Country:US
Practice Address - Phone:631-283-4300
Practice Address - Fax:631-283-8140
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116627-1207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY289901Medicare ID - Type UnspecifiedPROVIDER ID