Provider Demographics
NPI:1023168929
Name:WEINER, JOSEPH SCOTT (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:SCOTT
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 1:1010 NORTHERN BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5317
Mailing Address - Country:US
Mailing Address - Phone:516-336-2585
Mailing Address - Fax:516-336-2584
Practice Address - Street 1:1010 NORTHERN BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5317
Practice Address - Country:US
Practice Address - Phone:516-336-2585
Practice Address - Fax:516-336-2584
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1771262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE99930Medicare UPIN
NY98F161Medicare ID - Type Unspecified
NY01265067Medicare ID - Type Unspecified