Healthcare Provider Details

I. General information

NPI: 1467458547
Provider Name (Legal Business Name): HOWARD WEINER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1770 GRAND CONCOURSE
BRONX NY
10457-5524
US

IV. Provider business mailing address

1770 GRAND CONCOURSE
BRONX NY
10457-5524
US

V. Phone/Fax

Practice location:
  • Phone: 718-901-8110
  • Fax: 718-901-8121
Mailing address:
  • Phone: 718-901-8110
  • Fax: 718-901-8121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number031661-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: