Provider Demographics
NPI:1104086230
Name:WEINER, BRYNA F (PT)
Entity type:Individual
Prefix:DR
First Name:BRYNA
Middle Name:F
Last Name:WEINER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 ROOSEVELT AVE
Mailing Address - Street 2:72 ROUTE 27 LINCOLN HIGHWAY
Mailing Address - City:CARTERET
Mailing Address - State:NJ
Mailing Address - Zip Code:07008-1536
Mailing Address - Country:US
Mailing Address - Phone:732-541-2233
Mailing Address - Fax:
Practice Address - Street 1:1175 ROOSEVELT AVE
Practice Address - Street 2:72 ROUTE 27 LINCOLN HIGHWAY
Practice Address - City:CARTERET
Practice Address - State:NJ
Practice Address - Zip Code:07008-1536
Practice Address - Country:US
Practice Address - Phone:732-541-2233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA012740002083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1104086230Medicare PIN