Provider Demographics
NPI:1548401201
Name:WEINGART, PHILIP J
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:J
Last Name:WEINGART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 E MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-5219
Mailing Address - Country:US
Mailing Address - Phone:607-754-2440
Mailing Address - Fax:
Practice Address - Street 1:1207 E MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-5219
Practice Address - Country:US
Practice Address - Phone:607-754-2440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0050841156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01258231Medicaid
NYNY5084OtherEYEMED
NY1841375912OtherBLUE CROSS BLUE SHIELD
NY01258231Medicaid