Provider Demographics
NPI:1053398925
Name:WEINSTEIN, JEFFREY ROSS (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ROSS
Last Name:WEINSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:64 JEFFERSON ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-1148
Mailing Address - Country:US
Mailing Address - Phone:845-791-6400
Mailing Address - Fax:845-791-6406
Practice Address - Street 1:64 JEFFERSON ST
Practice Address - Street 2:SUITE 2
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-1148
Practice Address - Country:US
Practice Address - Phone:845-791-6400
Practice Address - Fax:845-791-6406
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY223670207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY264AP1Medicare PIN
NYI23404Medicare UPIN