MEDICARE: DR. BRIAN ENG DDS

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	122300000X	Dentist	056444	NY
2	122300000X	Dentist	22DI02500900	NJ

General Provider Information

NPI Number	:	1215289251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN ENG DDS

Provider Business Mailing Address
First Line	:	6 DOGWOOD CT
Second Line	:
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-3412
Country	:	US
Telephone Number	:	732-672-1945
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 E BURNSIDE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10453-4142
Country	:	US
Telephone Number	:	718-585-9204
Fax Number	:

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

Provider Enumeration Date	:	10/15/2012
Last Update Date	:	10/15/2012

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