Provider Demographics
NPI:1184712945
Name:WEINSTEIN, GARY (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:WEINSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:IGOR
Other - Middle Name:
Other - Last Name:VAYNSHTEYN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:79 THE DELL ST
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507
Mailing Address - Country:US
Mailing Address - Phone:718-661-1789
Mailing Address - Fax:718-830-0724
Practice Address - Street 1:107-21 QUEENS BLVD
Practice Address - Street 2:STE 6
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-661-1789
Practice Address - Fax:718-830-0724
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2038462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01733802Medicaid
02891Medicare ID - Type Unspecified
NY01733802Medicaid