Provider Demographics
NPI:1932150091
Name:WEINMAN, ELIZABETH LENORE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:LENORE
Last Name:WEINMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2242
Mailing Address - Country:US
Mailing Address - Phone:218-249-6980
Mailing Address - Fax:
Practice Address - Street 1:8900 VAN WYCK EXPRESSWAY
Practice Address - Street 2:4TH FLOOR, C BUILDING
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11418
Practice Address - Country:US
Practice Address - Phone:718-206-6894
Practice Address - Fax:718-206-8963
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47294208100000X
NY182441208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01589808Medicaid
MNF39164Medicare UPIN
MN332111800Medicaid