Healthcare Provider Details

I. General information

NPI: 1245225598
Provider Name (Legal Business Name): NATHANIEL WINER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLARKSON AVE SUITE A
BROOKLYN NY
11203-2056
US

IV. Provider business mailing address

450 CLARKSON AVE BOX 1205
BROOKLYN NY
11203-2056
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-6324
  • Fax: 718-270-2699
Mailing address:
  • Phone: 718-270-6320
  • Fax: 718-270-2699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number084401-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: