Provider Demographics
NPI:1831106228
Name:WEINBERGER, JEFFREY H (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:H
Last Name:WEINBERGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MILTIADES AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CT
Mailing Address - Zip Code:06878-2007
Mailing Address - Country:US
Mailing Address - Phone:203-637-0072
Mailing Address - Fax:203-637-7852
Practice Address - Street 1:25 MILTIADES AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CT
Practice Address - Zip Code:06878-2007
Practice Address - Country:US
Practice Address - Phone:203-637-0072
Practice Address - Fax:203-637-7852
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT23010207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD02623Medicare UPIN
CT110001059Medicare ID - Type Unspecified