MEDICARE: HEALTH PRACTITIONER SERVICES LLC

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	207R00000X	Internal Medicine Physician	185424	NY

General Provider Information

NPI Number	:	1760934459
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH PRACTITIONER SERVICES LLC

Provider Business Mailing Address
First Line	:	5014 16TH AVE
Second Line	:	SUITE 13
City	:	BROOKLYN
State	:	NY
Zip	:	11204-1404
Country	:	US
Telephone Number	:	914-359-4420
Fax Number	:	914-355-3035

Provider Business Practice Location Address
First Line	:	5014 16TH AVE
Second Line	:	SUITE 13
City	:	BROOKLYN
State	:	NY
Zip	:	11204-1404
Country	:	US
Telephone Number	:	914-359-4420
Fax Number	:	914-355-3035

Authorized Official
Title or Position	:	OWNER
Name	:	ARTHUR HOLMBERG
Credential	:	M.D.
Telephone Number	:	914-359-4420

Provider Enumeration Date	:	10/27/2016
Last Update Date	:	10/30/2016

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