Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 249846 | NY |
NPI | 1003077322 |
---|---|
Provider Name | Dr. Simon Fensterszaub |
First Address | Brooklyn, NY 11249-6588 |
Second Address | Brooklyn, NY 11249-6588 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2008 |
Last Update Date | 13/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03157917 | (05) | NY |