Healthcare Provider Details

I. General information

NPI: 1023256690
Provider Name (Legal Business Name): MARK H. WEINSTEIN, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 02/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 SHERMAN AVE 407
NEW HAVEN CT
06511-5238
US

IV. Provider business mailing address

136 SHERMAN AVE 407
NEW HAVEN CT
06511-5238
US

V. Phone/Fax

Practice location:
  • Phone: 203-624-0673
  • Fax:
Mailing address:
  • Phone: 203-624-0673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number018620
License Number StateCT

VIII. Authorized Official

Name: MARK H WEINSTEIN
Title or Position: PRESIDENT
Credential: MD
Phone: 203-624-0673