MEDICARE: MAG MEDICAL, PC

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	207R00000X	Internal Medicine Physician	196595	NY

General Provider Information

NPI Number	:	1215008040
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAG MEDICAL, PC

Provider Business Mailing Address
First Line	:	27 BEAUMONT ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-4103
Country	:	US
Telephone Number	:	718-375-0392
Fax Number	:	718-375-4324

Provider Business Practice Location Address
First Line	:	2379 65TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-4045
Country	:	US
Telephone Number	:	718-375-0392
Fax Number	:	718-375-4324

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ALEXANDER MERSON
Credential	:	MD
Telephone Number	:	718-375-0392

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	11/03/2009

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