Provider Demographics
NPI:1043288608
Name:WEINBERG, MARTIN R (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:R
Last Name:WEINBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 BROAD ST STE 104
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3061
Mailing Address - Country:US
Mailing Address - Phone:973-707-5632
Mailing Address - Fax:866-806-3675
Practice Address - Street 1:405 CEDAR LN STE 5
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-1739
Practice Address - Country:US
Practice Address - Phone:201-836-8333
Practice Address - Fax:201-836-7301
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147515207W00000X
NJ46646207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5615909Medicaid
520366Medicare ID - Type Unspecified
NJ5615909Medicaid