Healthcare Provider Details

I. General information

NPI: 1760456057
Provider Name (Legal Business Name): ALAN B. WEINER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 KINGS HWY S
CHERRY HILL NJ
08034-2500
US

IV. Provider business mailing address

474 GROVE ST
WORCESTER MA
01605-1214
US

V. Phone/Fax

Practice location:
  • Phone: 856-475-6166
  • Fax:
Mailing address:
  • Phone: 508-403-7877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number25MA11214200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number73864
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: