Basic Information
| Provider Information | |||||||||
| NPI: | 1639389315 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEINSTEIN | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | HERBERT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 CAPITAL WAY | ||||||||
| Address2: | STE 487 | ||||||||
| City: | PENNINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 085342521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098181900 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2 CAPITAL WAY | ||||||||
| Address2: | STE 487 | ||||||||
| City: | PENNINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 085342521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098181900 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2007 | ||||||||
| LastUpdateDate: | 07/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 25MA09388800 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | BP1-0022688 | 01 | INSTITUTIONAL PERMIT | OTHER |