Healthcare Provider Details

I. General information

NPI: 1891812194
Provider Name (Legal Business Name): MARIANNA M WEINER I.A.O.,DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 11/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1738 E 13TH ST
BROOKLYN NY
11229-1902
US

IV. Provider business mailing address

1738 E 13TH ST
BROOKLYN NY
11229-1902
US

V. Phone/Fax

Practice location:
  • Phone: 718-891-0606
  • Fax: 718-891-1055
Mailing address:
  • Phone: 718-891-0606
  • Fax: 718-891-1055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number045913
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number045913
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number045913
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number045913
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number045913
License Number StateNY
# 6
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number045913
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: