Healthcare Provider Details

I. General information

NPI: 1851190839
Provider Name (Legal Business Name): EVAN WEINGARTEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2025
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 BRIGHTON RD # 408
CLIFTON NJ
07012-1663
US

IV. Provider business mailing address

14416 72ND AVE APT B
FLUSHING NY
11367-2402
US

V. Phone/Fax

Practice location:
  • Phone: 703-393-9393
  • Fax:
Mailing address:
  • Phone: 516-445-1924
  • Fax: 516-445-1924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14823
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI03153300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: