MEDICARE: YEHUDIT WEINSTOCK SR.

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	103K00000X	Behavior Analyst	P06652	NY

General Provider Information

NPI Number	:	1538681333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YEHUDIT WEINSTOCK SR.

Provider Business Mailing Address
First Line	:	10 LEMBERG CT # 6
Second Line	:
City	:	MONROE
State	:	NY
Zip	:	10950-6582
Country	:	US
Telephone Number	:	845-782-3064
Fax Number	:

Provider Business Practice Location Address
First Line	:	1338 44TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-2108
Country	:	US
Telephone Number	:	718-304-9977
Fax Number	:

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

Provider Enumeration Date	:	07/13/2017
Last Update Date	:	03/17/2018

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