Provider Demographics
NPI:1942372529
Name:WEINSTEIN, SUSAN (OD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:WEINSTEIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18445 AVON RD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-5820
Mailing Address - Country:US
Mailing Address - Phone:718-591-0684
Mailing Address - Fax:
Practice Address - Street 1:15 W 65TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-6601
Practice Address - Country:US
Practice Address - Phone:212-769-6313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006261152W00000X, 156FC0800X, 156FC0801X, 156FX1700X, 156FX1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens
Not Answered156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter
Not Answered156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist
Not Answered156FX1900XEye and Vision Services ProvidersTechnician/TechnologistOrthoptist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT0062611Medicaid
NYU84728Medicare UPIN
NYT0062611Medicaid