Provider Demographics
NPI:1780900746
Name:WEINGARD, KERRI K (NP)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:K
Last Name:WEINGARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 BROADHOLLOW RD
Mailing Address - Street 2:SUITE 142
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3672
Mailing Address - Country:US
Mailing Address - Phone:516-931-0041
Mailing Address - Fax:
Practice Address - Street 1:1305 FRANKLIN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-1657
Practice Address - Country:US
Practice Address - Phone:516-746-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF302658363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner