MEDICARE: DEBORAH MACK

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	163W00000X	Registered Nurse	335500	NY

General Provider Information

NPI Number	:	1508264813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH MACK

Provider Business Mailing Address
First Line	:	2501 DAVIDSON AVE
Second Line	:	APT 6M
City	:	BRONX
State	:	NY
Zip	:	10468-4241
Country	:	US
Telephone Number	:	917-257-5802
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 DAVIDSON AVE
Second Line	:	APT 6M
City	:	BRONX
State	:	NY
Zip	:	10468-4241
Country	:	US
Telephone Number	:	917-257-5802
Fax Number	:

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

Provider Enumeration Date	:	12/18/2014
Last Update Date	:	12/18/2014

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Directions to “ DEBORAH MACK ” Practice Location

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