Provider Demographics
NPI:1306936778
Name:WEINER, LEE A (DC)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:A
Last Name:WEINER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3218 LONG BEACH RD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-4110
Mailing Address - Country:US
Mailing Address - Phone:516-255-2720
Mailing Address - Fax:516-255-9130
Practice Address - Street 1:9A DAVISON AVE.
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572
Practice Address - Country:US
Practice Address - Phone:516-255-0272
Practice Address - Fax:516-255-9130
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009660111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00108564OtherRRMR
NYX4E051Medicare ID - Type Unspecified