Provider Demographics
NPI:1316184005
Name:SIMON FAYNZILBERGMD PC
Entity Type:Organization
Organization Name:SIMON FAYNZILBERGMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:FAYNZILBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-817-2070
Mailing Address - Street 1:157 WINTHROP RD UNIT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-4642
Mailing Address - Country:US
Mailing Address - Phone:617-817-2070
Mailing Address - Fax:617-232-0515
Practice Address - Street 1:157 WINTHROP RD UNIT 2
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-4642
Practice Address - Country:US
Practice Address - Phone:617-817-2070
Practice Address - Fax:617-232-0515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA160820261QA1903X, 261QM2500X, 261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain