Healthcare Provider Details

I. General information

NPI: 1932107703
Provider Name (Legal Business Name): PAUL K. WEIN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 KINGS HWY SUITE D-6
BROOKLYN NY
11234-2644
US

IV. Provider business mailing address

3131 KINGS HWY SUITE D-6
BROOKLYN NY
11234-2644
US

V. Phone/Fax

Practice location:
  • Phone: 718-338-2283
  • Fax: 718-338-1783
Mailing address:
  • Phone: 718-338-2283
  • Fax: 718-338-1783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number137420
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number137420
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number171752
License Number StateNY

VIII. Authorized Official

Name: MRS. CATHERINE ROSE
Title or Position: OFFICE MANAGER
Credential: M.D.
Phone: 718-338-2283