Provider Demographics
NPI:1982613956
Name:WEINSTEIN, GARY J
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:J
Last Name:WEINSTEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 CHERRINGTON PKWY
Mailing Address - Street 2:
Mailing Address - City:MOON TWP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-4300
Mailing Address - Country:US
Mailing Address - Phone:412-269-0444
Mailing Address - Fax:412-269-1594
Practice Address - Street 1:650 CHERRINGTON PKWY
Practice Address - Street 2:
Practice Address - City:MOON TWP
Practice Address - State:PA
Practice Address - Zip Code:15108-4300
Practice Address - Country:US
Practice Address - Phone:412-269-0444
Practice Address - Fax:412-269-1594
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002646L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT27243Medicare UPIN
PA035517Medicare ID - Type Unspecified