MEDICARE: MEDGE-LEE NOEL

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	174400000X	Specialist		NY

General Provider Information

NPI Number	:	1467823476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEDGE-LEE NOEL

Provider Business Mailing Address
First Line	:	30 GLENMORE AVE
Second Line	:	APT 6E
City	:	BROOKLYN
State	:	NY
Zip	:	11212-6637
Country	:	US
Telephone Number	:	917-214-5474
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 GLENMORE AVE
Second Line	:	APT 6E
City	:	BROOKLYN
State	:	NY
Zip	:	11212-6637
Country	:	US
Telephone Number	:	917-214-5474
Fax Number	:

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

Provider Enumeration Date	:	10/16/2015
Last Update Date	:	10/16/2015

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Directions to “ MEDGE-LEE NOEL ” Practice Location

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