Provider Demographics
NPI:1891819207
Name:WEINER, ROBERT GREGG (DDS, PC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GREGG
Last Name:WEINER
Suffix:
Gender:M
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 ROUTE 100
Mailing Address - Street 2:BAILEY COURT
Mailing Address - City:SOMERS
Mailing Address - State:NY
Mailing Address - Zip Code:10589
Mailing Address - Country:US
Mailing Address - Phone:914-277-1100
Mailing Address - Fax:914-277-2873
Practice Address - Street 1:338 ROUTE 100
Practice Address - Street 2:BAILEY COURT
Practice Address - City:SOMERS
Practice Address - State:NY
Practice Address - Zip Code:10589
Practice Address - Country:US
Practice Address - Phone:914-277-1100
Practice Address - Fax:914-277-2873
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044623-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice