Provider Demographics
NPI:1962540666
Name:JEFFREY R. WEINER, M.D., INC.
Entity type:Organization
Organization Name:JEFFREY R. WEINER, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WEINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-579-1020
Mailing Address - Street 1:215 N SAN MATEO DR
Mailing Address - Street 2:SUITE # 10
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2622
Mailing Address - Country:US
Mailing Address - Phone:650-579-1020
Mailing Address - Fax:650-579-1027
Practice Address - Street 1:215 N SAN MATEO DR
Practice Address - Street 2:SUITE # 10
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2622
Practice Address - Country:US
Practice Address - Phone:650-579-1020
Practice Address - Fax:650-579-1027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG330032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G330030Medicaid