Provider Demographics
NPI:1194802173
Name:WEINSTOCK, JUDITH (MD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:
Last Name:WEINSTOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 COLUMBIA PLACE
Mailing Address - Street 2:STORE #8
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201
Mailing Address - Country:US
Mailing Address - Phone:718-935-9393
Mailing Address - Fax:347-529-5752
Practice Address - Street 1:10 COLUMBIA PLACE
Practice Address - Street 2:STORE #8
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201
Practice Address - Country:US
Practice Address - Phone:718-935-9393
Practice Address - Fax:347-529-5752
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162139174400000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00981631Medicaid
NY075D9610Medicare ID - Type Unspecified
NYA64161Medicare UPIN