MEDICARE: NY CENTER FOR EAR NOSE THROAT SINUS ALLERGY 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	174400000X	Specialist

General Provider Information

NPI Number	:	1649465535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NY CENTER FOR EAR NOSE THROAT SINUS ALLERGY LLP

Provider Business Mailing Address
First Line	:	2204 VOORHIES AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-2820
Country	:	US
Telephone Number	:	718-646-3776
Fax Number	:	718-648-4583

Provider Business Practice Location Address
First Line	:	2204 VOORHIES AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-2820
Country	:	US
Telephone Number	:	718-646-3776
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MR. MYRNA MOE
Credential	:
Telephone Number	:	718-646-3776

Provider Enumeration Date	:	09/13/2007
Last Update Date	:	09/14/2007

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