MEDICARE: MRS. MIRAV MIRIAM NEWMAN PT

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	2081P0010X	Pediatric Rehabilitation Medicine Physician	0161571	NY

General Provider Information

NPI Number	:	1215244868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MIRAV MIRIAM NEWMAN PT

Provider Business Mailing Address
First Line	:	532 COURT ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11231-3986
Country	:	US
Telephone Number	:	718-254-0800
Fax Number	:	718-254-0888

Provider Business Practice Location Address
First Line	:	532 COURT ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11231-3986
Country	:	US
Telephone Number	:	718-254-0800
Fax Number	:	718-254-0888

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

Provider Enumeration Date	:	09/02/2010
Last Update Date	:	09/02/2010

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