Basic Information
Provider Information
NPI: 1255407763
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WEINBERGER
FirstName: STEVEN
MiddleName: ELLIOTT
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3400 CIVIC CENTER BLVD FL 1
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191045161
CountryCode: US
TelephoneNumber: 2156623202
FaxNumber: 2153498432
Practice Location
Address1: 3400 CIVIC CENTER BLVD FL 1
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191045161
CountryCode: US
TelephoneNumber: 2156623202
FaxNumber: 2153498432
Other Information
ProviderEnumerationDate: 11/27/2006
LastUpdateDate: 09/27/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RP1001X42585MAN Allopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
207R00000XMD423780PAN Allopathic & Osteopathic PhysiciansInternal Medicine 
207RP1001XMD423780PAY Allopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease

No ID Information.


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