=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528357654
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MITCHELL R. EPSTEIN MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2011
-----------------------------------------------------
Last Update Date | 03/29/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3131 KINGS HWY SUITE D9
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11234-2644
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-258-7474
-----------------------------------------------------
Fax | 718-253-9024
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3131 KINGS HWY SUITE D9
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11234-2644
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-258-7474
-----------------------------------------------------
Fax | 718-253-9024
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MITCHELL ROY EPSTEIN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 718-258-7474
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number | 125438
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------