Provider Demographics
NPI:1639289994
Name:WEINSTEIN, NEIL ALAN (PT)
Entity Type:Individual
Prefix:MR
First Name:NEIL
Middle Name:ALAN
Last Name:WEINSTEIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 STATE ROUTE 17M
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-1643
Mailing Address - Country:US
Mailing Address - Phone:845-783-9854
Mailing Address - Fax:845-781-7916
Practice Address - Street 1:1019 STATE ROUTE 17M
Practice Address - Street 2:SUITE 1
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-1643
Practice Address - Country:US
Practice Address - Phone:845-783-9854
Practice Address - Fax:845-781-7916
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY13282225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03144Medicare PIN
NYQ81663Medicare PIN