Provider Demographics
NPI:1912025347
Name:WEINBERG, R LEONARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:R
Middle Name:LEONARD
Last Name:WEINBERG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:R
Other - Middle Name:LEONARD
Other - Last Name:WEINBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:22 CARDINAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-2718
Mailing Address - Country:US
Mailing Address - Phone:516-626-0352
Mailing Address - Fax:516-626-0352
Practice Address - Street 1:22 CARDINAL DRIVE
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-2718
Practice Address - Country:US
Practice Address - Phone:516-626-0352
Practice Address - Fax:516-626-0352
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01867411223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics