MEDICARE: BONIM LAMOKOM ZICHRON MOSHE DOV

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	251V00000X	Voluntary or Charitable Agency

General Provider Information

NPI Number	:	1528326691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BONIM LAMOKOM ZICHRON MOSHE DOV

Provider Business Mailing Address
First Line	:	425 E 9TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-5209
Country	:	US
Telephone Number	:	718-693-9032
Fax Number	:	718-693-9144

Provider Business Practice Location Address
First Line	:	425 E 9TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-5209
Country	:	US
Telephone Number	:	718-693-9032
Fax Number	:	718-693-9144

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	TALI ABRAMZON
Credential	:
Telephone Number	:	718-693-9032

Provider Enumeration Date	:	04/26/2012
Last Update Date	:	04/26/2012

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