Provider Demographics
NPI:1720101777
Name:WEINSTEIN, STANLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:
Last Name:WEINSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 HIGHWAY 70
Mailing Address - Street 2:SUITE B12
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5847
Mailing Address - Country:US
Mailing Address - Phone:732-370-8880
Mailing Address - Fax:
Practice Address - Street 1:525 HIGHWAY 70
Practice Address - Street 2:SUITE B12
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5847
Practice Address - Country:US
Practice Address - Phone:732-370-8880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA34375174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2224681290OtherBCBS ID
NJ1039934OtherHORIZON NJ HEALTH
NJ114333900OtherOWCP
NJ4093792OtherAETNA
NJP-1225071OtherOXFORD
NJ206085OtherUS FAMILY HEALTH PLAN
NJ3137601Medicaid
NJ20563857OtherBEECHSTREET
NJ114333900OtherOWCP
NJ20563857OtherBEECHSTREET