Provider Demographics
NPI:1679535017
Name:WEINER, DOUGLAS N (DPM)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:N
Last Name:WEINER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 WEBSTER AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-5205
Mailing Address - Country:US
Mailing Address - Phone:347-271-5338
Mailing Address - Fax:347-726-8264
Practice Address - Street 1:1150 WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-5205
Practice Address - Country:US
Practice Address - Phone:347-271-5338
Practice Address - Fax:347-726-8264
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0043481213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01052515Medicaid
NY01052515Medicaid
T51445Medicare UPIN