Healthcare Provider Details

I. General information

NPI: 1598357824
Provider Name (Legal Business Name): MICHELLE WEINBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2021
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 GRAND CONCOURSE APT 1E
BRONX NY
10468-1226
US

IV. Provider business mailing address

29 N AIRMONT RD STE 202
SUFFERN NY
10901-4221
US

V. Phone/Fax

Practice location:
  • Phone: 718-367-7645
  • Fax:
Mailing address:
  • Phone: 845-369-3703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number063022
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: