MEDICARE: POLINA KIPNIS-TSEITLINA, D.D.S.

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	1223G0001X	General Practice Dentistry	043875	NY

General Provider Information

NPI Number	:	1235305756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POLINA KIPNIS-TSEITLINA, D.D.S.

Provider Business Mailing Address
First Line	:	1916 KINGS HGHWAY 2ND FLOOR
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1314
Country	:	US
Telephone Number	:	718-627-8200
Fax Number	:	718-627-8212

Provider Business Practice Location Address
First Line	:	1916 KINGS HIGHWAY 2ND FLOOR
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1314
Country	:	US
Telephone Number	:	718-627-8200
Fax Number	:	718-627-8212

Authorized Official
Title or Position	:	GENERAL DENTIST
Name	:	DR. POLINA KIPNIS TSEITLINA
Credential	:	D.D.S
Telephone Number	:	718-627-8200

Provider Enumeration Date	:	05/05/2008
Last Update Date	:	05/05/2008

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