Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 175517 | NY |
N | 2084N0400X | Neurologist | 175517 | NY |
NPI | 1043254147 |
---|---|
Provider Name | Larry J. Weiner |
First Address | New York, NY 10023-4619 |
Second Address | New York, NY 10023-4619 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 01/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01777499 | (05) | NY |
E94725 | (02) | NY |