Provider Demographics
NPI:1962487629
Name:WEINGARTEN, SIDNEY R (MD)
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:R
Last Name:WEINGARTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12023
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-5023
Mailing Address - Country:US
Mailing Address - Phone:212-427-2666
Mailing Address - Fax:212-289-6929
Practice Address - Street 1:2510 30TH AVE
Practice Address - Street 2:ANESTHESIOLOGY
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-2448
Practice Address - Country:US
Practice Address - Phone:212-427-2666
Practice Address - Fax:212-289-6929
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174497-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01185400Medicaid
NYE87326Medicare UPIN
NY5L5141Medicare ID - Type Unspecified
NYG400000845Medicare PIN