Provider Demographics
NPI:1184695264
Name:WEINBERGER, MARCEL (OD)
Entity type:Individual
Prefix:DR
First Name:MARCEL
Middle Name:
Last Name:WEINBERGER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 CALDWELL AVE
Mailing Address - Street 2:
Mailing Address - City:N WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3619
Mailing Address - Country:US
Mailing Address - Phone:516-791-8855
Mailing Address - Fax:516-791-8855
Practice Address - Street 1:800 CALDWELL AVE
Practice Address - Street 2:
Practice Address - City:N WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11581-3619
Practice Address - Country:US
Practice Address - Phone:516-791-8855
Practice Address - Fax:516-791-8855
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003143-1152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00330718Medicaid
NY0159600001Medicare NSC
NY00330718Medicaid
NYT81449Medicare UPIN