Provider Demographics
NPI:1801947858
Name:WEINER, DAVID JONATHAN (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JONATHAN
Last Name:WEINER
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 1:1225 S OCEAN BLVD
Mailing Address - Street 2:903
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-6534
Mailing Address - Country:US
Mailing Address - Phone:561-278-8264
Mailing Address - Fax:
Practice Address - Street 1:1225 S OCEAN BLVD
Practice Address - Street 2:903
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-6534
Practice Address - Country:US
Practice Address - Phone:561-278-8264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120785207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCO8186Medicare UPIN
NY309981Medicare ID - Type Unspecified