Healthcare Provider Details

I. General information

NPI: 1578591012
Provider Name (Legal Business Name): NEIL J WEINER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2455 HOLLYWOOD BLVD STE 300
HOLLYWOOD FL
33020-6605
US

IV. Provider business mailing address

2455 HOLLYWOOD BLVD STE 300
HOLLYWOOD FL
33020-6605
US

V. Phone/Fax

Practice location:
  • Phone: 954-453-1113
  • Fax: 954-929-9513
Mailing address:
  • Phone: 954-453-1113
  • Fax: 954-929-9513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberOS 8273
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: