Provider Demographics
NPI:1851568844
Name:WEINMAN-GREENBERG, LENA (DO)
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:
Last Name:WEINMAN-GREENBERG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LENA
Other - Middle Name:
Other - Last Name:WEINMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:805 CENTURY MEDICAL DR STE C
Mailing Address - Street 2:CREDENTIALING OFFICE
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2100
Mailing Address - Country:US
Mailing Address - Phone:321-633-8663
Mailing Address - Fax:321-633-8618
Practice Address - Street 1:5005 PORT ST JOHN PKWY
Practice Address - Street 2:SUITE 2300
Practice Address - City:PORT ST JOHN
Practice Address - State:FL
Practice Address - Zip Code:32927-4305
Practice Address - Country:US
Practice Address - Phone:321-633-8663
Practice Address - Fax:321-633-8618
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO159950207V00000X
FLOS11760207V00000X
MI5101017769207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016165000Medicaid
FL016165000Medicaid