MEDICARE: AZIMUTH MEDICAL PC

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	208100000X	Physical Medicine & Rehabilitation Physician	250526	NY

General Provider Information

NPI Number	:	1083918593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AZIMUTH MEDICAL PC

Provider Business Mailing Address
First Line	:	157 MOTT ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10013-4230
Country	:	US
Telephone Number	:	917-886-0394
Fax Number	:

Provider Business Practice Location Address
First Line	:	308 GRAHAM AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11211-4904
Country	:	US
Telephone Number	:	917-886-0394
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARVIN MOY
Credential	:	MD
Telephone Number	:	917-886-0394

Provider Enumeration Date	:	12/28/2010
Last Update Date	:	12/28/2010

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