MEDICARE: EASTCOAST METROPOLITAN MEDICAL PC

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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	264999	NY

General Provider Information

NPI Number	:	1639416746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTCOAST METROPOLITAN MEDICAL PC

Provider Business Mailing Address
First Line	:	1928 BAY AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6214
Country	:	US
Telephone Number	:	718-975-2910
Fax Number	:	347-462-2227

Provider Business Practice Location Address
First Line	:	1928 BAY AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6214
Country	:	US
Telephone Number	:	718-975-2910
Fax Number	:	347-462-2227

Authorized Official
Title or Position	:	OWNER
Name	:	PAULINE RAITSES
Credential	:	DO
Telephone Number	:	718-975-2910

Provider Enumeration Date	:	01/09/2013
Last Update Date	:	01/14/2015

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