Provider Demographics
NPI:1508002023
Name:WEINGARTEN, GOLDIE
Entity Type:Individual
Prefix:
First Name:GOLDIE
Middle Name:
Last Name:WEINGARTEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 HOPE CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-1518
Mailing Address - Country:US
Mailing Address - Phone:917-859-9141
Mailing Address - Fax:
Practice Address - Street 1:613 HOPE CHAPEL RD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-1518
Practice Address - Country:US
Practice Address - Phone:917-859-9141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023563225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist