Healthcare Provider Details

I. General information

NPI: 1801869177
Provider Name (Legal Business Name): JAY S WEINGARTEN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 08/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 SE INDIAN ST STE 102
STUART FL
34997-5689
US

IV. Provider business mailing address

1233 SE INDIAN ST STE 102
STUART FL
34997-5689
US

V. Phone/Fax

Practice location:
  • Phone: 772-223-8313
  • Fax: 772-223-8675
Mailing address:
  • Phone: 772-223-8313
  • Fax: 772-223-8675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO2220
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: