Healthcare Provider Details

I. General information

NPI: 1730323049
Provider Name (Legal Business Name): MICHAEL WAINSTON, M.D.P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2009
Last Update Date: 04/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 MIDDLE NECK RD
GREAT NECK NY
11024-1402
US

IV. Provider business mailing address

928 MIDDLE NECK RD
GREAT NECK NY
11024-1402
US

V. Phone/Fax

Practice location:
  • Phone: 516-466-6996
  • Fax: 516-466-2390
Mailing address:
  • Phone: 516-466-6996
  • Fax: 516-466-2390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number080556
License Number StateNY

VIII. Authorized Official

Name: DR. MICHAEL WAINSTON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 516-466-6996