MEDICARE: DR. RUDOLPH WEINSTEIN D.D.S.

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	1223G0001X	General Practice Dentistry	33707	NY

General Provider Information

NPI Number	:	1760509442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUDOLPH WEINSTEIN D.D.S.

Provider Business Mailing Address
First Line	:	1673 E 28TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-2507
Country	:	US
Telephone Number	:	718-252-3420
Fax Number	:	718-252-3420

Provider Business Practice Location Address
First Line	:	1215 AVENUE M
Second Line	:	L2
City	:	BROOKLYN
State	:	NY
Zip	:	11230-5245
Country	:	US
Telephone Number	:	718-338-2299
Fax Number	:	718-338-2688

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/08/2007

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