Provider Demographics
NPI:1073506689
Name:WEINSTEIN, MARK (DC, RPH)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:WEINSTEIN
Suffix:
Gender:M
Credentials:DC, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CORNWALL DR
Mailing Address - Street 2:SUITE #204
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-3332
Mailing Address - Country:US
Mailing Address - Phone:732-651-8880
Mailing Address - Fax:732-651-0999
Practice Address - Street 1:4 CORNWALL DR
Practice Address - Street 2:SUITE #204
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3332
Practice Address - Country:US
Practice Address - Phone:732-651-8880
Practice Address - Fax:732-651-0999
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMCO4017111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU2438Medicare UPIN
NJWE697606Medicare ID - Type Unspecified