Healthcare Provider Details

I. General information

NPI: 1043254147
Provider Name (Legal Business Name): LARRY J. WEINER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 08/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 W 70TH ST SUITE 7
NEW YORK NY
10023-4619
US

IV. Provider business mailing address

58 W 70TH ST SUITE 7
NEW YORK NY
10023-4619
US

V. Phone/Fax

Practice location:
  • Phone: 212-362-0030
  • Fax:
Mailing address:
  • Phone: 212-362-0030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number175517
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number175517
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number175517
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: