Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 027452 | CT |
NPI | 1477634533 |
---|---|
Provider Name | Avi Weiner |
First Address | Stamford, CT 06905-5320 |
Second Address | Stamford, CT 06905-5320 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 19/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
027452 | LICENSE (01) | CT |
B37637 | (02) | CT |