Provider Demographics
NPI:1205914132
Name:WEINSTEIN, SCOTT ALLEN
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ALLEN
Last Name:WEINSTEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:SCOTT
Other - Middle Name:A
Other - Last Name:WEINSTEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:1805 215TH ST
Mailing Address - Street 2:2M
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-2155
Mailing Address - Country:US
Mailing Address - Phone:718-423-1913
Mailing Address - Fax:
Practice Address - Street 1:1805 215TH ST
Practice Address - Street 2:2M
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-2155
Practice Address - Country:US
Practice Address - Phone:718-423-1913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242228207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine