Provider Demographics
NPI:1336229350
Name:WEINGARTEN, PHYLLIS (MD)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:
Last Name:WEINGARTEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PHYLLIS
Other - Middle Name:
Other - Last Name:WEINGARTEN-KANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8 BAKER LN
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-2402
Mailing Address - Country:US
Mailing Address - Phone:845-362-8523
Mailing Address - Fax:
Practice Address - Street 1:4 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3516
Practice Address - Country:US
Practice Address - Phone:845-354-6225
Practice Address - Fax:845-354-6335
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173064 1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001139414001OtherUNITED HEALTHCARE
NY0D0325OtherHEALTHNET
NYRS134OtherOXFORD
NY040426011710OtherFIDELIS
NY1000063364OtherAFFINITY
NY460094OtherAETNA
NY6863353OtherCIGNA PPO
NY56F821OtherBLUE CROSS BLUE SHIELD
NY6863353OtherCIGNA PPO