Provider Demographics
NPI:1457622276
Name:LEE WEINER, DC
Entity type:Organization
Organization Name:LEE WEINER, DC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-255-0272
Mailing Address - Street 1:9A DAVISON AVE W
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-2132
Mailing Address - Country:US
Mailing Address - Phone:516-255-0272
Mailing Address - Fax:516-255-9130
Practice Address - Street 1:9A DAVISON AVE W
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-2132
Practice Address - Country:US
Practice Address - Phone:516-255-0272
Practice Address - Fax:516-255-9130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-25
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX09660111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
X4E051OtherMEDICARE PTAN
X4E051OtherMEDICARE PTAN