MEDICARE: MRS. REBECCA BETH BRICKMAN FNP-BC, CCRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	33 338858	NY
2	363LF0000X	Family Nurse Practitioner	26NJ00543800	NJ

General Provider Information

NPI Number	:	1164812483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBECCA BETH BRICKMAN FNP-BC, CCRN

Provider Business Mailing Address
First Line	:	7 ELDORADO DR
Second Line	:
City	:	CHESTNUT RIDGE
State	:	NY
Zip	:	10977-6407
Country	:	US
Telephone Number	:	845-304-5906
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 ELDORADO DR
Second Line	:
City	:	CHESTNUT RIDGE
State	:	NY
Zip	:	10977-6407
Country	:	US
Telephone Number	:	845-304-5906
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2015
Last Update Date	:	01/24/2015

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