Provider Demographics
NPI:1609965649
Name:WEINBERG, MARTIN (PHD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:WEINBERG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-2159
Mailing Address - Country:US
Mailing Address - Phone:516-484-9614
Mailing Address - Fax:
Practice Address - Street 1:83 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-2159
Practice Address - Country:US
Practice Address - Phone:516-484-9614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006128-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist