Provider Demographics
NPI:1740471762
Name:WEINBERG, ROBERT A (PTBSMA)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:A
Last Name:WEINBERG
Suffix:
Gender:M
Credentials:PTBSMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:763 CEDAR LANE
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598
Mailing Address - Country:US
Mailing Address - Phone:516-312-8655
Mailing Address - Fax:516-312-8655
Practice Address - Street 1:763 CEDAR LN
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-2610
Practice Address - Country:US
Practice Address - Phone:516-312-8655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010051-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01454131Medicaid
NYQ49321Medicare PIN