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General NPI Number Information
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NPI Number | 1750617890
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Entity Type | Individual
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Provider Name | MARK IAN WEINBERGER PH.D., MPH
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Gender | Male
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Dates
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Enumeration Date | 10/25/2009
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Last Update Date | 05/25/2011
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Provider Practice Location Address
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Address Line | 660 WHITE PLAINS RD SUITE 630
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City | TARRYTOWN
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State | NY
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Zip | 10591-5139
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Country | US
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Telephone | 914-323-0345
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Fax | 914-219-3171
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Provider Business Mailing Address
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Address Line | 660 WHITE PLAINS RD SUITE 630
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City | TARRYTOWN
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State | NY
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Zip | 10591-5139
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Country | US
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Telephone | 914-323-0345
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Fax | 914-219-3171
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 018126
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License Number State | NY
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