MEDICARE: MONOGRAM 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

General Provider Information

NPI Number	:	1619206364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONOGRAM MEDICAL, PC

Provider Business Mailing Address
First Line	:	1913 AVENUE Z
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3408
Country	:	US
Telephone Number	:	718-934-6661
Fax Number	:

Provider Business Practice Location Address
First Line	:	1913 AVENUE Z
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3408
Country	:	US
Telephone Number	:	718-934-6661
Fax Number	:	718-891-1417

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LANCE I AUSTEIN
Credential	:	M.D.
Telephone Number	:	718-934-6661

Provider Enumeration Date	:	12/09/2009
Last Update Date	:	12/09/2009

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