Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DS-019951-L | PA |
Y | 213EG0000X | General Practice | DS-019951-L | PA |
NPI | 1003037292 |
---|---|
Provider Name | Dr. Jeffrey Marc Weiner |
First Address | Philadelphia, PA 19114-1109 |
Second Address | Philadelphia, PA 19114-1109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 08/07/2007 |