MEDICARE: MIDWOOD FAMILY DOCTOR, 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	173000000X	Legal Medicine

General Provider Information

NPI Number	:	1508951450
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWOOD FAMILY DOCTOR, PLLC

Provider Business Mailing Address
First Line	:	1917 OCEAN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6801
Country	:	US
Telephone Number	:	718-951-0333
Fax Number	:	718-951-3774

Provider Business Practice Location Address
First Line	:	1917 OCEAN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6801
Country	:	US
Telephone Number	:	718-951-0333
Fax Number	:	718-951-3774

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. RAFAIL SIMON SHNAYDER
Credential	:	D.O.
Telephone Number	:	718-951-0333

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	08/22/2020

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