Provider Demographics
NPI:1548241540
Name:WEINREB, JEFFREY CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:CHARLES
Last Name:WEINREB
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 1:20 YORK ST
Mailing Address - Street 2:YNHH, SOUTH PAVILION, 2ND FL
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3220
Mailing Address - Country:US
Mailing Address - Phone:203-688-2433
Mailing Address - Fax:203-688-9258
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:YNHH, SOUTH PAVILION, 2ND FL
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-688-2433
Practice Address - Fax:203-688-9258
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0407682085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001407685Medicaid
A64320Medicare UPIN
CT300003316Medicare ID - Type Unspecified