MEDICARE: BARRY M WEINBERG DDS.PC.

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	122300000X	Dentist

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

General Provider Information

NPI Number	:	1558504209
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARRY M WEINBERG DDS.PC.

Provider Business Mailing Address
First Line	:	8340 AUSTIN ST
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-1833
Country	:	US
Telephone Number	:	718-847-4694
Fax Number	:	718-847-4695

Provider Business Practice Location Address
First Line	:	8340 AUSTIN ST
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-1833
Country	:	US
Telephone Number	:	718-847-4694
Fax Number	:	718-847-4695

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BARRY M WEINBERG
Credential	:	DDS
Telephone Number	:	718-847-4694

Provider Enumeration Date	:	04/10/2009
Last Update Date	:	04/10/2009

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