Provider Demographics
NPI:1790813145
Name:MICHAEL P WEINGARTEN DO PA
Entity Type:Organization
Organization Name:MICHAEL P WEINGARTEN DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:WEINGARTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-829-4225
Mailing Address - Street 1:745 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:NJ
Mailing Address - Zip Code:08065-1922
Mailing Address - Country:US
Mailing Address - Phone:856-829-4225
Mailing Address - Fax:856-829-7016
Practice Address - Street 1:745 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:NJ
Practice Address - Zip Code:08065-1922
Practice Address - Country:US
Practice Address - Phone:856-829-4225
Practice Address - Fax:856-829-7016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB025957207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0084811001OtherAMERIHEALTH
PA0084811001OtherKEYSTONE
NJ1130200Medicaid
CB4187OtherRR MEDICARE
140759OtherDEVON NETWORK
4298684OtherAETNA ELECTRONIC SUB ID#
P560037OtherOXFORD
F05065OtherHEALTHNET
NJ1099729OtherHORIZON NJ HEALTH
4298684OtherAETNA ELECTRONIC SUB ID#
=========OtherUNITED HEALTH CARE
F05065OtherHEALTHNET
CB4187OtherRR MEDICARE