MEDICARE: DR. PHILIP J WEINTRAUB

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	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	149-233-1	OTHER	NY	LICENSE NUMBER

General Provider Information

NPI Number	:	1629157813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP J WEINTRAUB

Provider Business Mailing Address
First Line	:	791 PARK AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-3551
Country	:	US
Telephone Number	:	212-737-7115
Fax Number	:

Provider Business Practice Location Address
First Line	:	791 PARK AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-3551
Country	:	US
Telephone Number	:	212-737-7115
Fax Number	:

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. PHILIP J WEINTRAUB ” Practice Location

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