MEDICARE: VISITING PHYSICIAN SERVICES OF NY

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	363A00000X	Physician Assistant	009320	NY

General Provider Information

NPI Number	:	1598829525
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISITING PHYSICIAN SERVICES OF NY

Provider Business Mailing Address
First Line	:	10106 QUEENS BLVD STE 2
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-2749
Country	:	US
Telephone Number	:	718-275-1485
Fax Number	:	718-332-7246

Provider Business Practice Location Address
First Line	:	2625 E 14TH ST STE 201
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3973
Country	:	US
Telephone Number	:	718-275-1485
Fax Number	:	718-332-7246

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ILYA BURSHTEYN
Credential	:	MD
Telephone Number	:	718-275-1485

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	05/22/2008

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