Provider Demographics
NPI:1790950475
Name:PHILIP J. WEINTRAUB, MD
Entity Type:Organization
Organization Name:PHILIP J. WEINTRAUB, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEVICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-737-7115
Mailing Address - Street 1:791 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3551
Mailing Address - Country:US
Mailing Address - Phone:212-737-7115
Mailing Address - Fax:212-737-5489
Practice Address - Street 1:791 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3551
Practice Address - Country:US
Practice Address - Phone:212-737-7115
Practice Address - Fax:212-737-5489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149233174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY53D071Medicare UPIN