MEDICARE: MRS. POLINA ZAGRANICHNAYA

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1558623850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. POLINA ZAGRANICHNAYA

Provider Business Mailing Address
First Line	:	2932 W 5TH ST
Second Line	:	APT 19C
City	:	BROOKLYN
State	:	NY
Zip	:	11224-3964
Country	:	US
Telephone Number	:	718-676-1850
Fax Number	:	718-676-1855

Provider Business Practice Location Address
First Line	:	2932 W 5TH ST
Second Line	:	APT 19C
City	:	BROOKLYN
State	:	NY
Zip	:	11224-3964
Country	:	US
Telephone Number	:	718-676-1850
Fax Number	:	718-676-1855

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

Provider Enumeration Date	:	06/12/2012
Last Update Date	:	06/12/2012

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