MEDICARE: LYUDMILA SHTEIN DO

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	207Q00000X	Family Medicine Physician	259564	NY

General Provider Information

NPI Number	:	1013297118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYUDMILA SHTEIN DO

Provider Business Mailing Address
First Line	:	352 52ND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-1810
Country	:	US
Telephone Number	:	718-684-1760
Fax Number	:	718-684-1757

Provider Business Practice Location Address
First Line	:	1068 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-2303
Country	:	US
Telephone Number	:	718-684-1760
Fax Number	:	718-684-1757

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

Provider Enumeration Date	:	08/19/2011
Last Update Date	:	10/17/2017

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