Healthcare Provider Details

I. General information

NPI: 1629252630
Provider Name (Legal Business Name): GARY LEE WEINBERGER D.D.S.,M.SC.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1097 OLD COUNTRY RD SUITE 203
PLAINVIEW NY
11803-6505
US

IV. Provider business mailing address

1097 OLD COUNTRY RD SUITE 203
PLAINVIEW NY
11803-6505
US

V. Phone/Fax

Practice location:
  • Phone: 516-822-4554
  • Fax: 516-822-3408
Mailing address:
  • Phone: 516-822-4554
  • Fax: 516-822-3408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberNY032166
License Number StateNY

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: