Provider Demographics
NPI:1710148200
Name:FREDERICK M WEINTRAUB
Entity Type:Organization
Organization Name:FREDERICK M WEINTRAUB
Other - Org Name:ALPINE/NORTHERNVALLEY PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEINTRAUB
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-784-1828
Mailing Address - Street 1:153 PARIS AVE STE A
Mailing Address - Street 2:
Mailing Address - City:NORTHVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07647-2054
Mailing Address - Country:US
Mailing Address - Phone:201-784-1828
Mailing Address - Fax:201-784-1611
Practice Address - Street 1:153 PARIS AVE STE A
Practice Address - Street 2:
Practice Address - City:NORTHVALE
Practice Address - State:NJ
Practice Address - Zip Code:07647-2054
Practice Address - Country:US
Practice Address - Phone:201-784-1828
Practice Address - Fax:201-784-1611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2008-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00178500213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherUNITED HEALTHCARE
NJ=========OtherUNITED HEALTHCARE
NJ536466Medicare PIN