Healthcare Provider Details

I. General information

NPI: 1003973421
Provider Name (Legal Business Name): GERALD STEVEN WEINSTEIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 SHERMAN ST
WATERTOWN NY
13601-3612
US

IV. Provider business mailing address

228 SHERMAN ST
WATERTOWN NY
13601-3612
US

V. Phone/Fax

Practice location:
  • Phone: 315-788-9849
  • Fax: 315-788-9458
Mailing address:
  • Phone: 315-788-9849
  • Fax: 315-788-9458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number144232
License Number StateNY

VIII. Authorized Official

Name: SUE E STORINO
Title or Position: OFFICE MANAGER
Credential:
Phone: 315-788-9849