Provider Demographics
NPI:1942292206
Name:WEINSTEIN, MITCHELL I (DO)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:I
Last Name:WEINSTEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 MONTAUK HWY STE 2
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4400
Mailing Address - Country:US
Mailing Address - Phone:631-321-3840
Mailing Address - Fax:631-321-3842
Practice Address - Street 1:631 MONTAUK HWY STE 2
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4400
Practice Address - Country:US
Practice Address - Phone:631-321-3840
Practice Address - Fax:631-321-3842
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162637207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01416811Medicaid
NYE20437Medicare UPIN
NYW88001Medicare ID - Type UnspecifiedGROUP #
NY23F831Medicare ID - Type UnspecifiedINDIV #