MEDICARE: MANHATTAN BEACH MEDICAL.P.C.

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	221650	NY

General Provider Information

NPI Number	:	1245305648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANHATTAN BEACH MEDICAL.P.C.

Provider Business Mailing Address
First Line	:	105 ORIENTAL BLVD STE 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-4124
Country	:	US
Telephone Number	:	917-846-2297
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 ORIENTAL BLVD STE 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-4124
Country	:	US
Telephone Number	:	917-846-2297
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARINA MARGULIS
Credential	:	M.D.
Telephone Number	:	917-846-2297

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	08/22/2020

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