Provider Demographics
NPI:1891943742
Name:JAY M. WEINSTEIN, PH.D., P.A.
Entity Type:Organization
Organization Name:JAY M. WEINSTEIN, PH.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DURETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-366-2700
Mailing Address - Street 1:1399 NW 17TH AVE
Mailing Address - Street 2:SUITE 306D
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-2349
Mailing Address - Country:US
Mailing Address - Phone:305-545-1110
Mailing Address - Fax:305-545-0211
Practice Address - Street 1:1399 NW 17TH AVE
Practice Address - Street 2:SUITE 306D
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-2349
Practice Address - Country:US
Practice Address - Phone:305-545-1110
Practice Address - Fax:305-545-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3266103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1992813125OtherINDIVIDUAL NPI
FL1992813125OtherINDIVIDUAL NPI
FLS00232Medicare UPIN