Provider Demographics
NPI:1508951450
Name:MIDWOOD FAMILY DOCTOR, PLLC
Entity Type:Organization
Organization Name:MIDWOOD FAMILY DOCTOR, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAIL
Authorized Official - Middle Name:SIMON
Authorized Official - Last Name:SHNAYDER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-951-0333
Mailing Address - Street 1:1917 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-6801
Mailing Address - Country:US
Mailing Address - Phone:718-951-0333
Mailing Address - Fax:718-951-3774
Practice Address - Street 1:1917 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-6801
Practice Address - Country:US
Practice Address - Phone:718-951-0333
Practice Address - Fax:718-951-3774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW89071Medicare ID - Type Unspecified