MEDICARE: MS. POLINA KIPNIS DDS

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	1223G0001X	General Practice Dentistry	0438751	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C1279	OTHER	NY	HEALTH PLEX
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	016715	OTHER	NY	DORAL

General Provider Information

NPI Number	:	1588647358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. POLINA KIPNIS DDS

Provider Business Mailing Address
First Line	:	1916 KINGS HWY
Second Line	:	2ND FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1314
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1916 KINGS HWY
Second Line	:	2ND FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1314
Country	:	US
Telephone Number	:	718-627-8200
Fax Number	:	718-627-8200

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/25/2005
Last Update Date	:	07/08/2007

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