MEDICARE: SANFORD R WERT MD 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	174400000X	Specialist	128807	NY

General Provider Information

NPI Number	:	1730529058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANFORD R WERT MD PC

Provider Business Mailing Address
First Line	:	3075 BRIGHTON 13TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-5607
Country	:	US
Telephone Number	:	718-332-4747
Fax Number	:	718-332-0414

Provider Business Practice Location Address
First Line	:	3075 BRIGHTON 13TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-5607
Country	:	US
Telephone Number	:	718-332-4747
Fax Number	:	718-332-0414

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	ROZA VINOGRADOV
Credential	:
Telephone Number	:	718-332-4747

Provider Enumeration Date	:	07/01/2013
Last Update Date	:	07/01/2013

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