Provider Demographics
NPI:1558521419
Name:WEINER, SUZANNE B (MD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:B
Last Name:WEINER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17685 BONIELLO RD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-1509
Mailing Address - Country:US
Mailing Address - Phone:561-988-9279
Mailing Address - Fax:
Practice Address - Street 1:17685 BONIELLO RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-1509
Practice Address - Country:US
Practice Address - Phone:561-988-9279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL65621207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine