Provider Demographics
NPI:1104095439
Name:JAY J WEINSTEIN, MD, INC
Entity type:Organization
Organization Name:JAY J WEINSTEIN, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-743-4053
Mailing Address - Street 1:2424 E 21ST ST
Mailing Address - Street 2:SUITE 425
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-1711
Mailing Address - Country:US
Mailing Address - Phone:918-743-4053
Mailing Address - Fax:918-743-2845
Practice Address - Street 1:2424 E 21ST ST
Practice Address - Street 2:SUITE 425
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-1711
Practice Address - Country:US
Practice Address - Phone:918-743-4053
Practice Address - Fax:918-743-2845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10096174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKD35391Medicare UPIN