Provider Demographics
NPI:1871506485
Name:WEINSTOCK, LISA R (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:R
Last Name:WEINSTOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-2563
Mailing Address - Country:US
Mailing Address - Phone:201-444-4484
Mailing Address - Fax:201-444-4148
Practice Address - Street 1:79 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-2563
Practice Address - Country:US
Practice Address - Phone:201-444-4484
Practice Address - Fax:201-444-4148
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA056101002085R0202X
NY1952112085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY195211OtherNYS LICENSE
NY195211OtherNYS LICENSE
079033Medicare ID - Type Unspecified