MEDICARE: DR. LAURIE JILL KIRSTEIN MD

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	208600000X	Surgery Physician	227808	MA
2	2086X0206X	Surgical Oncology Physician	25MA08240300	NJ
3	208600000X	Surgery Physician	250647	NY

General Provider Information

NPI Number	:	1285677922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURIE JILL KIRSTEIN MD

Provider Business Mailing Address
First Line	:	300 E 66TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10065-6800
Country	:	US
Telephone Number	:	646-888-5206
Fax Number	:	646-888-4921

Provider Business Practice Location Address
First Line	:	300 E 66TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10065-6800
Country	:	US
Telephone Number	:	646-888-5206
Fax Number	:	646-888-4921

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

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	06/06/2016

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