Provider Demographics
NPI:1972691814
Name:WEINER, PETER ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:ROBERT
Last Name:WEINER
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 3445
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-1897
Mailing Address - Country:US
Mailing Address - Phone:908-686-7542
Mailing Address - Fax:973-334-4253
Practice Address - Street 1:96 MILLBURN AVE
Practice Address - Street 2:SUITE 200A
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1944
Practice Address - Country:US
Practice Address - Phone:908-686-7542
Practice Address - Fax:973-334-4253
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2010-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA47728207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0700801Medicaid
C54756Medicare UPIN
000445573Medicare ID - Type Unspecified