MEDICARE: PAUL SHIFRIN 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	207L00000X	Anesthesiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	243496	OTHER	NY	LICENSE

General Provider Information

NPI Number	:	1275850570
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAUL SHIFRIN MEDICAL PC

Provider Business Mailing Address
First Line	:	3733 MERMAID AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-1218
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3733 MERMAID AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-1218
Country	:	US
Telephone Number	:	718-222-5999
Fax Number	:

Authorized Official
Title or Position	:	TREASURER
Name	:	PAUL SHIFRIN
Credential	:
Telephone Number	:	646-338-2975

Provider Enumeration Date	:	04/26/2010
Last Update Date	:	04/26/2010

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