MEDICARE: SHVARTSFNP INC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1669135455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHVARTSFNP INC

Provider Business Mailing Address
First Line	:	2277 HOMECREST AVE APT 2C
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4130
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2277 HOMECREST AVE APT 2C
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4130
Country	:	US
Telephone Number	:	917-560-4565
Fax Number	:	226-909-0424

Authorized Official
Title or Position	:	OWNER
Name	:	MIKHAIL SHVARTS
Credential	:	NP
Telephone Number	:	917-560-4565

Provider Enumeration Date	:	10/19/2021
Last Update Date	:	10/19/2021

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