Active NPI
Frederic Weinbaum, M.D.
- Surgery Physician
- Flushing, NY
National Provider Identifier
1023065430
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 137911
- Practice address
- 5645 Main St
RM-M204
Flushing, NY 11355-5045 - Phone
- (718) 445-0220
- Fax
- (718) 939-1167
- NPI assigned
- May 30, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 137911 | NY | Primary |
| Surgical Critical Care Physician | 2086S0102X | 137911 | NY | |
| Vascular Surgery Physician | 2086S0129X | 137911 | NY |
Addresses
Primary practice location
5645 Main St
RM-M204
Flushing, NY 11355-5045
Mailing address
5645 Main St
RM-M204
Flushing, NY 11355-5045
Phone (718) 445-0220
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00648522 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| South Fork Medical Associates PC | Surgery | Past | Accepting new patients |
| CRT Surgical Associates, PC | Surgery | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Surgery Physician
- Flushing, NY
- NPI 1083774640
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148947200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1204761600000",
"number": "1023065430",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5645 MAIN ST",
"address_2": "RM-M204",
"city": "FLUSHING",
"state": "NY",
"postal_code": "113555045",
"telephone_number": "718-445-0220",
"fax_number": "718-939-1167"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5645 MAIN ST",
"address_2": "RM-M204",
"city": "FLUSHING",
"state": "NY",
"postal_code": "113555045",
"telephone_number": "718-445-0220",
"fax_number": "718-939-1167"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEINBAUM",
"first_name": "FREDERIC",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-30",
"last_updated": "2008-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "NY",
"license": "137911",
"primary": true
},
{
"code": "2086S0102X",
"taxonomy_group": "",
"desc": "Surgery, Surgical Critical Care",
"state": "NY",
"license": "137911",
"primary": false
},
{
"code": "2086S0129X",
"taxonomy_group": "",
"desc": "Surgery, Vascular Surgery",
"state": "NY",
"license": "137911",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00648522",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Flushing, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.