Provider Demographics
NPI:1538341078
Name:MICHAEL D. WEINTHAL D.P.M.
Entity type:Organization
Organization Name:MICHAEL D. WEINTHAL D.P.M.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WEINTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-391-1113
Mailing Address - Street 1:74 PASCACK RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PARK RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07656-1935
Mailing Address - Country:US
Mailing Address - Phone:201-391-1113
Mailing Address - Fax:201-391-1114
Practice Address - Street 1:74 PASCACK RD
Practice Address - Street 2:SUITE 6
Practice Address - City:PARK RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07656-1935
Practice Address - Country:US
Practice Address - Phone:201-391-1113
Practice Address - Fax:201-391-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00115100213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ450152Medicare PIN
NJT45110Medicare UPIN
NJ0792330001Medicare NSC