Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 25MB02218600 | NJ |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 25MB02218600 | NJ |
NPI | 1124062625 |
---|---|
Provider Name | Dr. George T. Weinberger |
First Address | Cliffside Park, NJ 07010 |
Second Address | Cliffside Park, NJ 07010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 06/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000511657 | (05) | NJ |
E53108 | (02) | NJ |