MEDICARE: BI TAO B NG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	785257	NY

General Provider Information

NPI Number	:	1003361544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BI TAO B NG

Provider Business Mailing Address
First Line	:	2179 65TH ST APT 5A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-3954
Country	:	US
Telephone Number	:	917-232-7737
Fax Number	:

Provider Business Practice Location Address
First Line	:	1318 60TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-5018
Country	:	US
Telephone Number	:	718-686-5948
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2016
Last Update Date	:	08/24/2016

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Directions to “ BI TAO B NG ” Practice Location

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