Provider Demographics
NPI:1700643962
Name:WEINSTEIN, DAVA
Entity Type:Individual
Prefix:
First Name:DAVA
Middle Name:
Last Name:WEINSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DAVA
Other - Middle Name:
Other - Last Name:ROSENTHAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:8 ANDOVER DR
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-6302
Mailing Address - Country:US
Mailing Address - Phone:516-662-2870
Mailing Address - Fax:
Practice Address - Street 1:8 ANDOVER DR
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-6302
Practice Address - Country:US
Practice Address - Phone:516-662-2870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist