Provider Demographics
NPI:1770771958
Name:ADON S WEINBERG DO INC
Entity type:Organization
Organization Name:ADON S WEINBERG DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADON
Authorized Official - Middle Name:S
Authorized Official - Last Name:WEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-759-9595
Mailing Address - Street 1:4247 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1089
Mailing Address - Country:US
Mailing Address - Phone:330-759-9595
Mailing Address - Fax:330-759-9597
Practice Address - Street 1:4247 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-1089
Practice Address - Country:US
Practice Address - Phone:330-759-9595
Practice Address - Fax:330-759-9597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-3133W207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0455029Medicaid
OH9326372Medicare PIN
OH9326371Medicare PIN
OH0455029Medicaid