Healthcare Provider Details

I. General information

NPI: 1891943742
Provider Name (Legal Business Name): JAY M. WEINSTEIN, PH.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 11/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1399 NW 17TH AVE SUITE 306D
MIAMI FL
33125-2349
US

IV. Provider business mailing address

1399 NW 17TH AVE SUITE 306D
MIAMI FL
33125-2349
US

V. Phone/Fax

Practice location:
  • Phone: 305-545-1110
  • Fax: 305-545-0211
Mailing address:
  • Phone: 305-545-1110
  • Fax: 305-545-0211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY3266
License Number StateFL

VIII. Authorized Official

Name: MR. ALAN DURETZ
Title or Position: BILLING MANAGER
Credential:
Phone: 954-366-2700