Healthcare Provider Details

I. General information

NPI: 1548455090
Provider Name (Legal Business Name): CATSKILL ADULT & PED MED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 JEFFERSON ST SUITE 2
MONTICELLO NY
12701-1148
US

IV. Provider business mailing address

64 JEFFERSON ST SUITE 2
MONTICELLO NY
12701-1148
US

V. Phone/Fax

Practice location:
  • Phone: 845-791-6400
  • Fax: 845-791-6406
Mailing address:
  • Phone: 845-791-6400
  • Fax: 845-791-6406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberWZZRP1
License Number StateNY

VIII. Authorized Official

Name: DR. JEFFREY ROSS WEINSTEIN
Title or Position: PARTNER
Credential: MD
Phone: 845-796-3079