MEDICARE: MARK WEINSTEIN D.C., R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	MCO4017	NJ

General Provider Information

NPI Number	:	1073506689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK WEINSTEIN D.C., R.PH.

Provider Business Mailing Address
First Line	:	4 CORNWALL DR
Second Line	:	SUITE #204
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-3332
Country	:	US
Telephone Number	:	732-651-8880
Fax Number	:	732-651-0999

Provider Business Practice Location Address
First Line	:	4 CORNWALL DR
Second Line	:	SUITE #204
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-3332
Country	:	US
Telephone Number	:	732-651-8880
Fax Number	:	732-651-0999

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	07/08/2007

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