Provider Demographics
NPI:1831382548
Name:WEINGARTEN, MICHAEL P (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:WEINGARTEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 CHAPEL AVENUE, WEST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002
Mailing Address - Country:US
Mailing Address - Phone:856-667-9051
Mailing Address - Fax:856-667-9054
Practice Address - Street 1:2250 CHAPEL AVENUE, WEST
Practice Address - Street 2:SUITE 110
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-2051
Practice Address - Country:US
Practice Address - Phone:856-667-9051
Practice Address - Fax:856-667-9054
Is Sole Proprietor?:No
Enumeration Date:2007-08-26
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB25957207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1130200Medicaid
NJ140759ASDMedicare PIN
NJ1130200Medicaid