MEDICARE: MODERN MEDICAL CARE OF NY PLLC

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	219028-1	NY
2	207L00000X	Anesthesiology Physician	219028-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225462617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MODERN MEDICAL CARE OF NY PLLC

Provider Business Mailing Address
First Line	:	8766 23RD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-5202
Country	:	US
Telephone Number	:	917-767-2918
Fax Number	:	718-435-3489

Provider Business Practice Location Address
First Line	:	717 56TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-3503
Country	:	US
Telephone Number	:	718-435-3890
Fax Number	:	718-435-3489

Authorized Official
Title or Position	:	ANESTHESIOLOGIST/OWNER
Name	:	MR. DEYE WEI
Credential	:	M.D.
Telephone Number	:	917-767-2918

Provider Enumeration Date	:	08/21/2013
Last Update Date	:	08/21/2013

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