MEDICARE: NINA DAYEN DO 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	207R00000X	Internal Medicine Physician	250014	NY

General Provider Information

NPI Number	:	1093012312
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NINA DAYEN DO PC

Provider Business Mailing Address
First Line	:	1775 E 13TH ST APT 4H
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1932
Country	:	US
Telephone Number	:	917-613-5966
Fax Number	:	347-587-6814

Provider Business Practice Location Address
First Line	:	1009 BRIGHTON BEACH AVE STE 302
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-5659
Country	:	US
Telephone Number	:	718-975-0657
Fax Number	:	718-975-0659

Authorized Official
Title or Position	:	PHYSICIAN - INTERNAL MEDICINE
Name	:	NINA DAYEN
Credential	:	DO
Telephone Number	:	917-613-5966

Provider Enumeration Date	:	02/23/2011
Last Update Date	:	10/21/2011

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