Healthcare Provider Details

I. General information

NPI: 1891720272
Provider Name (Legal Business Name): COREY J WEINER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 04/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 ELMONT RD
ELMONT NY
11003-4002
US

IV. Provider business mailing address

545 ELMONT RD
ELMONT NY
11003-4002
US

V. Phone/Fax

Practice location:
  • Phone: 516-495-7129
  • Fax: 516-977-2874
Mailing address:
  • Phone: 516-495-7129
  • Fax: 516-977-2874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMA46748
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number239107
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: