Individual
MRS. SHANA WEINERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
16 CEDAR ST, KINGS PARK, NY 11754-2534
(631) 678-6810
Mailing address
25 OLYMPIA PL, EAST NORTHPORT, NY 11731-4023
(631) 368-1059
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
0087111
NY
Other
Enumeration date
01/28/2007
Last updated
07/08/2007
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