Healthcare Provider Details

I. General information

NPI: 1366376774
Provider Name (Legal Business Name): INDEPENDENT SPINE SURGEONS OF NEW YORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 W 45TH ST # 902
NEW YORK NY
10036-0385
US

IV. Provider business mailing address

2025 BROADWAY APT 29A
NEW YORK NY
10023-5046
US

V. Phone/Fax

Practice location:
  • Phone: 516-814-2139
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID WEINTRAUB
Title or Position: PRESIDENT
Credential: MD
Phone: 917-446-1047