=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104095439
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAY J WEINSTEIN, MD, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2008
-----------------------------------------------------
Last Update Date | 02/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2424 E 21ST ST SUITE 425
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74114-1711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-743-4053
-----------------------------------------------------
Fax | 918-743-2845
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2424 E 21ST ST SUITE 425
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74114-1711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-743-4053
-----------------------------------------------------
Fax | 918-743-2845
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MS. JUDY BROWN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 918-743-4053
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 10096
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------