Healthcare Provider Details

I. General information

NPI: 1679287049
Provider Name (Legal Business Name): CLAUDINE WEINER ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2023
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 OLD TOWN RD
SETAUKET NY
11733-3482
US

IV. Provider business mailing address

19 EASTVIEW DR
SOUND BEACH NY
11789-1021
US

V. Phone/Fax

Practice location:
  • Phone: 631-730-4900
  • Fax:
Mailing address:
  • Phone: 631-252-5883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: