MEDICARE: DR. ALEXANDER AYZENBERG

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	1223G0001X	General Practice Dentistry	043869	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700803459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDER AYZENBERG

Provider Business Mailing Address
First Line	:	2809 LEN DR
Second Line	:
City	:	BELLMORE
State	:	NY
Zip	:	11710-5203
Country	:	US
Telephone Number	:	516-679-0692
Fax Number	:

Provider Business Practice Location Address
First Line	:	134 BRIGHTON 11TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-5327
Country	:	US
Telephone Number	:	718-368-3750
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	07/08/2007

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