Provider Demographics
NPI:1912087412
Name:WEINTRAUB, RICHARD G (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:G
Last Name:WEINTRAUB
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6
Mailing Address - Street 2:
Mailing Address - City:VAILS GATE
Mailing Address - State:NY
Mailing Address - Zip Code:12584-0006
Mailing Address - Country:US
Mailing Address - Phone:845-561-6305
Mailing Address - Fax:845-561-7857
Practice Address - Street 1:1401 ROUTE 300
Practice Address - Street 2:NEWBURGH MALL
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-2990
Practice Address - Country:US
Practice Address - Phone:845-561-6305
Practice Address - Fax:845-561-7857
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002766-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0344150001Medicare ID - Type Unspecified