Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD424798 | PA |
N | 2080P0204X | Pediatric Emergency Doctor | D59689 | MD |
NPI | 1154370633 |
---|---|
Provider Name | Ari Yehuda Weintraub |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104-4399 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 10/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1021243780001 | (05) | PA |
234720EJL | MEDICARE PTAN (01) | PA |