Healthcare Provider Details

I. General information

NPI: 1417953720
Provider Name (Legal Business Name): AUREN STEVE WEINBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 03/25/2022
Certification Date: 03/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 S 19TH ST APT 1407
PHILADELPHIA PA
19103-4679
US

IV. Provider business mailing address

112 S 19TH ST APT 1407
PHILADELPHIA PA
19103-4679
US

V. Phone/Fax

Practice location:
  • Phone: 267-907-3097
  • Fax:
Mailing address:
  • Phone: 267-907-3097
  • Fax: 215-493-1470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME146146
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD068622L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: