Provider Demographics
NPI:1366528481
Name:WEINBERG, HOWARD D (OD)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:D
Last Name:WEINBERG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 ROUTE 112
Mailing Address - Street 2:SUITE L
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-2232
Mailing Address - Country:US
Mailing Address - Phone:631-736-6161
Mailing Address - Fax:631-736-1912
Practice Address - Street 1:1850 ROUTE 112
Practice Address - Street 2:SUITE L
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-2232
Practice Address - Country:US
Practice Address - Phone:631-736-6161
Practice Address - Fax:631-736-1912
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004022-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00656377Medicaid
NY0027794OtherGHI
NY00656377Medicaid
NYA400043543Medicare PIN