Provider Demographics
NPI:1174755193
Name:FAINBERG, MARINA (DDS)
Entity type:Individual
Prefix:DR
First Name:MARINA
Middle Name:
Last Name:FAINBERG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6317 4TH AVE
Mailing Address - Street 2:DENTAL DEPT.
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-4922
Mailing Address - Country:US
Mailing Address - Phone:718-907-8100
Mailing Address - Fax:718-492-8544
Practice Address - Street 1:6317 4TH AVE
Practice Address - Street 2:DENTAL DEPT.
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-4922
Practice Address - Country:US
Practice Address - Phone:718-907-8100
Practice Address - Fax:718-492-8544
Is Sole Proprietor?:No
Enumeration Date:2009-08-10
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY50 0547031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice