Provider Demographics
NPI:1598818643
Name:WEINBERG, NEIL ALAN (L AC)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:ALAN
Last Name:WEINBERG
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 W YATES ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-3556
Mailing Address - Country:US
Mailing Address - Phone:607-275-9697
Mailing Address - Fax:
Practice Address - Street 1:301 W STATE ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5431
Practice Address - Country:US
Practice Address - Phone:607-275-9697
Practice Address - Fax:607-697-0153
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000773-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist