Provider Demographics
NPI:1457601783
Name:WEINSTEIN, BRUCE STUART
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:STUART
Last Name:WEINSTEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4235 EDGMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:19015-2315
Mailing Address - Country:US
Mailing Address - Phone:610-876-3365
Mailing Address - Fax:610-876-4880
Practice Address - Street 1:4235 EDGMONT AVE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:PA
Practice Address - Zip Code:19015-2315
Practice Address - Country:US
Practice Address - Phone:610-876-3365
Practice Address - Fax:610-876-4880
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAD00580332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies