Healthcare Provider Details

I. General information

NPI: 1578539698
Provider Name (Legal Business Name): GEORGE WEINGARTEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1158 FIFTH AVENUE
NYC NY
10029
US

IV. Provider business mailing address

1158 FIFTH AVENUE
NYC NY
10029
US

V. Phone/Fax

Practice location:
  • Phone: 212-734-4019
  • Fax: 212-410-5089
Mailing address:
  • Phone: 212-734-4019
  • Fax: 212-410-5089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number097306
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: