Healthcare Provider Details

I. General information

NPI: 1316184005
Provider Name (Legal Business Name): SIMON FAYNZILBERGMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2009
Last Update Date: 01/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 WINTHROP RD UNIT 2
BROOKLINE MA
02445-4642
US

IV. Provider business mailing address

157 WINTHROP RD UNIT 2
BROOKLINE MA
02445-4642
US

V. Phone/Fax

Practice location:
  • Phone: 617-817-2070
  • Fax: 617-232-0515
Mailing address:
  • Phone: 617-817-2070
  • Fax: 617-232-0515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number160820
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number160820
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number160820
License Number StateMA

VIII. Authorized Official

Name: DR. SIMON FAYNZILBERG
Title or Position: PRESIDENT
Credential:
Phone: 617-817-2070