Provider Demographics
NPI:1124062625
Name:WEINBERGER, GEORGE T (DO)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:T
Last Name:WEINBERGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 B ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010
Mailing Address - Country:US
Mailing Address - Phone:201-861-1851
Mailing Address - Fax:201-861-1853
Practice Address - Street 1:705 B ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010
Practice Address - Country:US
Practice Address - Phone:201-861-1851
Practice Address - Fax:201-861-1853
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB02218600207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ000511657Medicaid
NJ222864225Medicare ID - Type Unspecified
NJ000511657Medicaid