MEDICARE: ADAPTATION MEDICAL PC

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	215829	NY
2	174400000X	Specialist	220248	NY

General Provider Information

NPI Number	:	1366792509
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADAPTATION MEDICAL PC

Provider Business Mailing Address
First Line	:	1534 BROADWAY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-4249
Country	:	US
Telephone Number	:	718-576-6266
Fax Number	:	718-576-6269

Provider Business Practice Location Address
First Line	:	1534 BROADWAY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-4249
Country	:	US
Telephone Number	:	718-576-6266
Fax Number	:	718-576-6269

Authorized Official
Title or Position	:	OWNER
Name	:	VLADIMIR ONEFATER
Credential	:	M.D.
Telephone Number	:	718-576-6266

Provider Enumeration Date	:	09/14/2012
Last Update Date	:	10/12/2012

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