Provider Demographics
NPI:1639190333
Name:WEINSTOCK, DEBRA (DPM)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:WEINSTOCK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15120 88TH ST STE LL
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-2034
Mailing Address - Country:US
Mailing Address - Phone:718-835-0100
Mailing Address - Fax:718-843-2233
Practice Address - Street 1:15120 88TH ST STE LL
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-2034
Practice Address - Country:US
Practice Address - Phone:718-835-0100
Practice Address - Fax:718-843-2233
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0003821-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY94788Medicare ID - Type Unspecified
NY1316040001Medicare NSC
NYT32186Medicare UPIN