Healthcare Provider Details

I. General information

NPI: 1508951450
Provider Name (Legal Business Name): MIDWOOD FAMILY DOCTOR, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1917 OCEAN AVE
BROOKLYN NY
11230-6801
US

IV. Provider business mailing address

1917 OCEAN AVE
BROOKLYN NY
11230-6801
US

V. Phone/Fax

Practice location:
  • Phone: 718-951-0333
  • Fax: 718-951-3774
Mailing address:
  • Phone: 718-951-0333
  • Fax: 718-951-3774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: DR. RAFAIL SIMON SHNAYDER
Title or Position: MEDICAL DIRECTOR
Credential: D.O.
Phone: 718-951-0333