Provider Demographics
NPI:1891720272
Name:WEINER, COREY J (MD)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:J
Last Name:WEINER
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 1:545 ELMONT RD
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4002
Mailing Address - Country:US
Mailing Address - Phone:516-495-7129
Mailing Address - Fax:516-977-2874
Practice Address - Street 1:545 ELMONT RD
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-4002
Practice Address - Country:US
Practice Address - Phone:516-495-7129
Practice Address - Fax:516-977-2874
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA467482085R0202X
NY2391072085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05219906Medicaid
NYA400110464Medicare PIN
D20042Medicare UPIN