Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | X009660 | NY |
NPI | 1306936778 |
---|---|
Provider Name | Dr. Lee A Weiner |
First Address | Oceanside, NY 11572-4110 |
Second Address | Oceanside, NY 11572 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 29/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P00108564 | RRMR (01) | GA |