Provider Demographics
NPI:1336419704
Name:LEWIS J WEINSTEIN M D P C
Entity Type:Organization
Organization Name:LEWIS J WEINSTEIN M D P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEINSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:631-499-3733
Mailing Address - Street 1:66 COMMACK ROAD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-3405
Mailing Address - Country:US
Mailing Address - Phone:631-499-3733
Mailing Address - Fax:631-499-3710
Practice Address - Street 1:66 COMMACK RD
Practice Address - Street 2:SUITE 203
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-3405
Practice Address - Country:US
Practice Address - Phone:631-499-3733
Practice Address - Fax:631-499-3710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-03
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138663174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00715875Medicaid
NY00715875Medicaid