Provider Demographics
NPI:1992709430
Name:WEINSTOCK, MARK R (DPM, CWS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:WEINSTOCK
Suffix:
Gender:M
Credentials:DPM, CWS
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Mailing Address - Street 1:240 W PASSAIC ST
Mailing Address - Street 2:STE 4
Mailing Address - City:MAYWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07607-1264
Mailing Address - Country:US
Mailing Address - Phone:201-880-6000
Mailing Address - Fax:201-880-5999
Practice Address - Street 1:240 W PASSAIC ST
Practice Address - Street 2:SUITE 4
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607-1264
Practice Address - Country:US
Practice Address - Phone:201-880-6000
Practice Address - Fax:201-880-5999
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYNOO4606213E00000X
NJ25MD00199400213E00000X
MAPD1985213E00000X
MI5901002193213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU06482Medicare UPIN