Healthcare Provider Details

I. General information

NPI: 1124060108
Provider Name (Legal Business Name): BARRY WEINBERGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 08/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UMDNJ-RWJ MEDICAL SCHOOL 1 RWJ PLACE DEPT OF PEDIATRICS MEB 312-B
NEW BRUNSWICK NJ
08901
US

IV. Provider business mailing address

66 WEST GILBERT ST
RED BANK NJ
07701
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-5684
  • Fax: 732-235-6609
Mailing address:
  • Phone: 732-212-0051
  • Fax: 732-212-0713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA05898100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: