Provider Demographics
NPI:1871253542
Name:WEINSTOCK, SAMUEL JAMES
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:JAMES
Last Name:WEINSTOCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 258
Mailing Address - Street 2:
Mailing Address - City:CROSS RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10518-0258
Mailing Address - Country:US
Mailing Address - Phone:845-531-1528
Mailing Address - Fax:
Practice Address - Street 1:25 COUNTY CENTER RD APT C-15
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10607-1522
Practice Address - Country:US
Practice Address - Phone:845-531-1528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY103K00000XMedicaid