Basic Information
| Provider Information | |||||||||
| NPI: | 1336212703 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEINER | ||||||||
| FirstName: | SHOSHANA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 474 COURT AVE | ||||||||
| Address2: | |||||||||
| City: | CEDARHURST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115161534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163740352 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1825 EASTCHESTER RD | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104612301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189043146 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2006 | ||||||||
| LastUpdateDate: | 06/04/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F333233 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | F333233 | 01 | NY | NEW YORK STATE LICENSE | OTHER | 02700205 | 05 | NY | MEDICAID | 2006003724 | 01 | ANCC | OTHER |