Provider Demographics
NPI:1881751634
Name:WEINER, DORON (MD)
Entity type:Individual
Prefix:
First Name:DORON
Middle Name:
Last Name:WEINER
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 1:2209 MERRICK ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566
Mailing Address - Country:US
Mailing Address - Phone:516-546-5000
Mailing Address - Fax:516-546-0596
Practice Address - Street 1:242 MERRICK RD
Practice Address - Street 2:SUITE 301
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-5254
Practice Address - Country:US
Practice Address - Phone:516-536-1455
Practice Address - Fax:516-536-1455
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1809071207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
485835OtherAETNA
5100138OtherGHI
NY01520896Medicaid
NY01520896Medicaid
5100138OtherGHI