MEDICARE: UNIVERSITY ORTHOPEDICS OF NEW YORK 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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	192054	NY
2	207X00000X	Orthopaedic Surgery Physician	192054	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	WEN041	OTHER	NY	EMPIRE MEDICARE
2	WEN042	OTHER	NY	EMPIRE MEDICARE

General Provider Information

NPI Number	:	1588654636
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY ORTHOPEDICS OF NEW YORK PLLC

Provider Business Mailing Address
First Line	:	2318 31ST ST
Second Line	:	SUITE 210
City	:	ASTORIA
State	:	NY
Zip	:	11105-2892
Country	:	US
Telephone Number	:	718-777-1885
Fax Number	:	718-777-9613

Provider Business Practice Location Address
First Line	:	2318 31ST ST
Second Line	:	SUITE 210
City	:	ASTORIA
State	:	NY
Zip	:	11105-2892
Country	:	US
Telephone Number	:	718-777-1885
Fax Number	:	718-777-9613

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MARTA TECZA
Credential	:
Telephone Number	:	718-777-1885

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	02/13/2008

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Directions to “UNIVERSITY ORTHOPEDICS OF NEW YORK PLLC ” Practice Location

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