Provider Demographics
NPI:1851334684
Name:WEINTRAUB, ELIZABETH C (DPM)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:C
Last Name:WEINTRAUB
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 786
Mailing Address - Street 2:GREYSTONE STATION
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-0786
Mailing Address - Country:US
Mailing Address - Phone:914-966-8818
Mailing Address - Fax:914-966-8814
Practice Address - Street 1:970 N BROADWAY STE 308A
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1311
Practice Address - Country:US
Practice Address - Phone:914-966-8818
Practice Address - Fax:914-966-8814
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005195213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01819290Medicaid
NYP6485WAA521Medicare PIN
NY01819290Medicaid
NYP64851Medicare PIN
NY659431001Medicare PIN