Healthcare Provider Details

I. General information

NPI: 1194523837
Provider Name (Legal Business Name): INDEPENDENT NEUROSURGERY OF WEST VIRGINIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 03/07/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 1ST AVE
HUNTINGTON WV
25702-1241
US

IV. Provider business mailing address

2025 BROADWAY APT 29D
NEW YORK NY
10023-5017
US

V. Phone/Fax

Practice location:
  • Phone: 516-814-2139
  • Fax:
Mailing address:
  • Phone: 917-446-1047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID WEINTRAUB
Title or Position: PRESIDENT
Credential: MD
Phone: 917-446-1047