Provider Demographics
NPI:1992700454
Name:WEINGER, ELLIOTT B (MD)
Entity type:Individual
Prefix:DR
First Name:ELLIOTT
Middle Name:B
Last Name:WEINGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4455
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33008-4455
Mailing Address - Country:US
Mailing Address - Phone:954-454-3335
Mailing Address - Fax:954-454-1991
Practice Address - Street 1:1724 E HALLANDALE BEACH BLVD
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-5584
Practice Address - Country:US
Practice Address - Phone:954-454-3335
Practice Address - Fax:954-454-1991
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME32539174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL79319WMedicare PIN
FLD86343Medicare UPIN