Provider Demographics
NPI:1689660565
Name:WEINBERG, JEFFREY M (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:WEINBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:200 RIVERSIDE BLVD APT 7I
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10069-0908
Mailing Address - Country:US
Mailing Address - Phone:917-309-3881
Mailing Address - Fax:913-490-1906
Practice Address - Street 1:8002 KEW GARDENS RD STE 107
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-3600
Practice Address - Country:US
Practice Address - Phone:718-459-0900
Practice Address - Fax:718-459-0910
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2023-05-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY206843207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01756087Medicaid
NY01756087Medicaid
G54043Medicare UPIN