MEDICARE: DR. BENJAMIN WEINTRAUB M.D.

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	208000000X	Pediatrics Physician	0420010804	VT
2	208000000X	Pediatrics Physician	2006025651	MO
3	208000000X	Pediatrics Physician	253273	NY

General Provider Information

NPI Number	:	1386639011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN WEINTRAUB M.D.

Provider Business Mailing Address
First Line	:	200 W 90TH ST
Second Line	:	APT 9D
City	:	NEW YORK
State	:	NY
Zip	:	10024-1234
Country	:	US
Telephone Number	:	646-863-2652
Fax Number	:

Provider Business Practice Location Address
First Line	:	3444 KOSSUTH AVE
Second Line	:	MONTEFIORE MEDICAL GROUP/ FAMILY CARE CENTER
City	:	BRONX
State	:	NY
Zip	:	10467-2410
Country	:	US
Telephone Number	:	718-920-7857
Fax Number	:

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

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	08/25/2009

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