Healthcare Provider Details

I. General information

NPI: 1700961745
Provider Name (Legal Business Name): SENYA VAYNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1761 E 12TH ST
BROOKLYN NY
11229-1013
US

IV. Provider business mailing address

1761 E 12TH ST
BROOKLYN NY
11229-1013
US

V. Phone/Fax

Practice location:
  • Phone: 718-336-1111
  • Fax: 718-336-2624
Mailing address:
  • Phone: 718-336-1111
  • Fax: 718-336-2624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number162592
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: