Provider Demographics
NPI:1629157813
Name:WEINTRAUB, PHILIP J
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:J
Last Name:WEINTRAUB
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 1:791 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3551
Mailing Address - Country:US
Mailing Address - Phone:212-737-7115
Mailing Address - Fax:
Practice Address - Street 1:791 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3551
Practice Address - Country:US
Practice Address - Phone:212-737-7115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY149-233-1OtherLICENSE NUMBER
NY53D071Medicare ID - Type Unspecified
NY149-233-1OtherLICENSE NUMBER