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NPI Code Detail

MEDICARE: GRIGORY SHTENDER PHYSICIAN,PC

MEDICARE: GRIGORY SHTENDER PHYSICIAN,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
1174400000XSpecialist218261NY

General Provider Information

NPI Number : 1396817094
Entity Type Code : Organization
Provider Name (Legal Business Name) : GRIGORY SHTENDER PHYSICIAN,PC
Provider Business Mailing Address
First Line : 139 QUENTIN RD
Second Line :
City : BROOKLYN
State : NY
Zip : 11223-1201
Country : US
Telephone Number : 718-368-0100
Fax Number : 718-368-1208
Provider Business Practice Location Address
First Line : 3001 BRIGHTON 1ST ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11235-8008
Country : US
Telephone Number : 718-368-0100
Fax Number : 718-368-1208
Authorized Official
Title or Position : PRESIDENT
Name : GRIGORY SHTENDER
Credential : MD
Telephone Number : 718-368-0100
Provider Enumeration Date : 11/15/2006
Last Update Date : 09/20/2007

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