MEDICARE: JERRY C WEINBERG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	MD028446E	PA
2	207W00000X	Ophthalmology Physician	219927	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306890785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERRY C WEINBERG MD

Provider Business Mailing Address
First Line	:	236A MOORE STREET
Second Line	:	PENNSPORT MALL
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148
Country	:	US
Telephone Number	:	215-755-9470
Fax Number	:	215-755-9860

Provider Business Practice Location Address
First Line	:	1215 AVENUE M
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-5245
Country	:	US
Telephone Number	:	718-965-2020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	07/08/2007

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