Provider Demographics
NPI:1578271458
Name:WEINBERG, ERICA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:
Last Name:WEINBERG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 E MAIN ST STE 103
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8413
Mailing Address - Country:US
Mailing Address - Phone:631-665-5580
Mailing Address - Fax:
Practice Address - Street 1:387 E MAIN ST STE 103
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8413
Practice Address - Country:US
Practice Address - Phone:631-665-5580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0628831223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics