Provider Demographics
NPI:1710996889
Name:WEIN DIAGNOSTIC MEDICAL SERVICES PC
Entity Type:Organization
Organization Name:WEIN DIAGNOSTIC MEDICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-267-8196
Mailing Address - Street 1:2106 23RD ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-3625
Mailing Address - Country:US
Mailing Address - Phone:718-267-8196
Mailing Address - Fax:
Practice Address - Street 1:2781 3RD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-4002
Practice Address - Country:US
Practice Address - Phone:718-267-8196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1402212085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00870842Medicaid
NY1477578177OtherINDIVIDUAL NPI
NYB79303Medicare UPIN
NY76A322Medicare ID - Type Unspecified