MEDICARE: NEWKIRK AVENUE OFFICE BASED SURGICAL, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	4342	NY

General Provider Information

NPI Number	:	1184987588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEWKIRK AVENUE OFFICE BASED SURGICAL, PLLC

Provider Business Mailing Address
First Line	:	1414 NEWKIRK AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-6522
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	603 RUGBY RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-1581
Country	:	US
Telephone Number	:	718-759-6100
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. RAZ WINIARSKY
Credential	:	MD
Telephone Number	:	718-759-6100

Provider Enumeration Date	:	06/20/2012
Last Update Date	:	08/01/2012

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