Healthcare Provider Details

I. General information

NPI: 1265423081
Provider Name (Legal Business Name): GERALD S WEINSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2005
Last Update Date: 03/20/2015
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:
Title or Position:
Credential:
Phone: