MEDICARE: MIRON FAYNGERSH MD

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	174400000X	Specialist	197845	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902918279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRON FAYNGERSH MD

Provider Business Mailing Address
First Line	:	745 OCEAN PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-1113
Country	:	US
Telephone Number	:	718-677-9700
Fax Number	:	718-859-5969

Provider Business Practice Location Address
First Line	:	745 OCEAN PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-1113
Country	:	US
Telephone Number	:	718-677-9700
Fax Number	:	718-859-5969

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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Directions to “ MIRON FAYNGERSH MD” Practice Location

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