Healthcare Provider Details

I. General information

NPI: 1245498385
Provider Name (Legal Business Name): MITCHELL WEINBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 10/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 COMMUNITY DR
MANHASSET NY
11030-3816
US

IV. Provider business mailing address

300 COMMUNITY DR
MANHASSET NY
11030-3816
US

V. Phone/Fax

Practice location:
  • Phone: 516-562-4100
  • Fax: 516-562-2087
Mailing address:
  • Phone: 516-562-4100
  • Fax: 516-562-2087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number239438
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number239438
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number25MA09041900
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: