Provider Demographics
NPI:1932290301
Name:WEINTRAUB, GEORGE (DPM)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:WEINTRAUB
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 W 93RD ST
Mailing Address - Street 2:APT 6C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-7665
Mailing Address - Country:US
Mailing Address - Phone:212-864-3619
Mailing Address - Fax:212-402-1752
Practice Address - Street 1:57 W 93RD ST
Practice Address - Street 2:APT 6C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-7665
Practice Address - Country:US
Practice Address - Phone:212-864-3619
Practice Address - Fax:212-402-1752
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003822213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00888739Medicaid
NYP40501Medicare ID - Type Unspecified