MEDICARE: GREGORY SUPRIN MD 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	207Q00000X	Family Medicine Physician	230165	NY

General Provider Information

NPI Number	:	1336272228
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREGORY SUPRIN MD PLLC

Provider Business Mailing Address
First Line	:	1381B LINDEN BLVD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11212-4701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1381B LINDEN BLVD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11212-4701
Country	:	US
Telephone Number	:	718-498-3103
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	GREGORY SUPRIN
Credential	:
Telephone Number	:	718-498-3103

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	11/27/2007

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