=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740319607
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTER FOR ORTHOPAEDIC SURGERY, LLP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2007
-----------------------------------------------------
Last Update Date | 04/23/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3612 E TREMONT AVE
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10465-2039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-409-9494
-----------------------------------------------------
Fax | 718-824-8026
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3612 E TREMONT AVE
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10465-2039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-409-9494
-----------------------------------------------------
Fax | 718-824-8026
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. EIAL FAIERMAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 718-409-9494
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XS0106X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Hand Surgery Physician
-----------------------------------------------------
License Number | 209052
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207XX0005X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
-----------------------------------------------------
License Number | 209052
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 209052
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------