MEDICARE: JACOB BINYAMINOV

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1750951265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB BINYAMINOV

Provider Business Mailing Address
First Line	:	2626 E 14TH ST STE 101H
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3976
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2626 E 14TH ST STE 101H
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3976
Country	:	US
Telephone Number	:	917-498-6948
Fax Number	:

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

Provider Enumeration Date	:	06/28/2021
Last Update Date	:	06/28/2021

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