Provider Demographics
NPI:1619462819
Name:WEINGARTEN, ALIZA FRIDA (MSED)
Entity Type:Individual
Prefix:
First Name:ALIZA
Middle Name:FRIDA
Last Name:WEINGARTEN
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WALTER DR.
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-5669
Mailing Address - Country:US
Mailing Address - Phone:845-425-3142
Mailing Address - Fax:
Practice Address - Street 1:17 WALTER DR
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-3130
Practice Address - Country:US
Practice Address - Phone:845-425-3142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NY566775277174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist