Basic Information
| Provider Information | |||||||||
| NPI: | 1184987588 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEWKIRK AVENUE OFFICE BASED SURGICAL, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1414 NEWKIRK AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112266522 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 603 RUGBY RD | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112301581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187596100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2012 | ||||||||
| LastUpdateDate: | 08/01/2012 | ||||||||
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| AuthorizedOfficialLastName: | WINIARSKY | ||||||||
| AuthorizedOfficialFirstName: | RAZ | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7187596100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 4342 | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.