Provider Demographics
NPI:1386747947
Name:PHILLIP FYMAN AND ALEXANDER WEINGARTEN MD PC
Entity type:Organization
Organization Name:PHILLIP FYMAN AND ALEXANDER WEINGARTEN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:LABIENIEC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-496-4964
Mailing Address - Street 1:366 N BROADWAY STE 305
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2000
Mailing Address - Country:US
Mailing Address - Phone:516-496-4964
Mailing Address - Fax:516-496-4950
Practice Address - Street 1:366 N BROADWAY STE 305
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2000
Practice Address - Country:US
Practice Address - Phone:516-496-4964
Practice Address - Fax:516-496-4950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW38101Medicare UPIN