MEDICARE: METRO PHYSICIAN ASSOCIATES LLP

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	207UN0901X	Nuclear Cardiology Physician	114071	NY

General Provider Information

NPI Number	:	1609025964
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METRO PHYSICIAN ASSOCIATES LLP

Provider Business Mailing Address
First Line	:	PO BOX 1816
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10159-1816
Country	:	US
Telephone Number	:	212-475-8066
Fax Number	:	212-475-4175

Provider Business Practice Location Address
First Line	:	11014 JAMAICA AVE
Second Line	:
City	:	RICHMOND HILL
State	:	NY
Zip	:	11418-2320
Country	:	US
Telephone Number	:	212-475-8066
Fax Number	:	212-475-4175

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. KENNETH JOHN HERWIG II
Credential	:	MD
Telephone Number	:	212-475-8066

Provider Enumeration Date	:	09/11/2008
Last Update Date	:	09/11/2008

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