Provider Demographics
NPI:1417956418
Name:FAYNZILBERG, SIMON (MD)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:
Last Name:FAYNZILBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 WINTHROP RD # 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:781-457-1410
Practice Address - Street 1:157 WINTHROP RD # 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:781-457-1410
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA160820207L00000X
NH14220207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30201347Medicaid
ME435405099Medicaid
MA3200183Medicaid
NH30201347Medicaid
H000865Medicare UPIN
MAH00865Medicare UPIN