MEDICARE: JENNA MISELL

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	171W00000X	Contractor

General Provider Information

NPI Number	:	1376937730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA MISELL

Provider Business Mailing Address
First Line	:	2741 E 64TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-6821
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2741 E 64TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-6821
Country	:	US
Telephone Number	:	646-296-8952
Fax Number	:

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

Provider Enumeration Date	:	03/24/2015
Last Update Date	:	03/24/2015

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Directions to “ JENNA MISELL ” Practice Location

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