MEDICARE: NEW YORK VEIN CENTER

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	261QA1903X	Ambulatory Surgical Clinic/Center	139939	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1760583900	OTHER	NY	NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316276868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW YORK VEIN CENTER

Provider Business Mailing Address
First Line	:	2989 OCEAN PARKWAY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235
Country	:	US
Telephone Number	:	718-996-4400
Fax Number	:	718-449-3807

Provider Business Practice Location Address
First Line	:	2989 OCEAN PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-8386
Country	:	US
Telephone Number	:	718-996-4400
Fax Number	:	718-449-3807

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID M GLASS
Credential	:	M.D.
Telephone Number	:	718-996-4400

Provider Enumeration Date	:	12/11/2009
Last Update Date	:	12/11/2009

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Directions to “NEW YORK VEIN CENTER ” Practice Location

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