Healthcare Provider Details

I. General information

NPI: 1770779449
Provider Name (Legal Business Name): HELEN WEINBERG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2007
Last Update Date: 09/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13514 JEWEL AVE
FLUSHING NY
11367-1920
US

IV. Provider business mailing address

13514 JEWEL AVE
FLUSHING NY
11367-1920
US

V. Phone/Fax

Practice location:
  • Phone: 718-997-6453
  • Fax:
Mailing address:
  • Phone: 718-997-6453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number051385
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: