Provider Demographics
NPI:1669470548
Name:WEIN, PAUL KENNETH (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:KENNETH
Last Name:WEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3131 KINGS HWY
Mailing Address - Street 2:SUITE D-6
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-2644
Mailing Address - Country:US
Mailing Address - Phone:718-338-2283
Mailing Address - Fax:718-338-1783
Practice Address - Street 1:3131 KINGS HWY
Practice Address - Street 2:SUITE D-6
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-2644
Practice Address - Country:US
Practice Address - Phone:718-338-2283
Practice Address - Fax:718-338-1783
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY137420207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00586172Medicaid
NYC10144Medicare UPIN
NY00586172Medicaid