=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578766747
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEVEN PHILIP WEINBERG DMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1725 WYNNEWOOD DR
-----------------------------------------------------
City | VINELAND
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08361-6753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-305-0525
-----------------------------------------------------
Fax | 856-692-1048
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1725 WYNNEWOOD DR
-----------------------------------------------------
City | VINELAND
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08361-6753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-305-0525
-----------------------------------------------------
Fax | 856-692-1048
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 22DI01059500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------