Healthcare Provider Details

I. General information

NPI: 1417956418
Provider Name (Legal Business Name): SIMON FAYNZILBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 08/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 WINTHROP RD # 2
BROOKLINE MA
02445-4642
US

IV. Provider business mailing address

157 WINTHROP RD # 2
BROOKLINE MA
02445-4642
US

V. Phone/Fax

Practice location:
  • Phone: 617-817-2070
  • Fax: 781-457-1410
Mailing address:
  • Phone: 617-817-2070
  • Fax: 781-457-1410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number160820
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number14220
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: