Provider Demographics
NPI:1801869177
Name:WEINGARTEN, JAY S (DPM)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:S
Last Name:WEINGARTEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 SE INDIAN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-5689
Mailing Address - Country:US
Mailing Address - Phone:772-223-8313
Mailing Address - Fax:772-223-8675
Practice Address - Street 1:1233 SE INDIAN ST STE 102
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-5689
Practice Address - Country:US
Practice Address - Phone:772-223-8313
Practice Address - Fax:772-223-8675
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2220213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390034700Medicaid
650534263OtherEIN
FL390034700Medicaid
65234SMedicare ID - Type Unspecified