Healthcare Provider Details

I. General information

NPI: 1710996889
Provider Name (Legal Business Name): WEIN DIAGNOSTIC MEDICAL SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2781 3RD AVE
BRONX NY
10455-4002
US

IV. Provider business mailing address

2106 23RD ST
ASTORIA NY
11105-3625
US

V. Phone/Fax

Practice location:
  • Phone: 718-267-8196
  • Fax:
Mailing address:
  • Phone: 718-267-8196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number140221
License Number StateNY

VIII. Authorized Official

Name: DR. ELLIOTT WEIN
Title or Position: OWNER
Credential: M.D.
Phone: 718-267-8196