MEDICARE: MORTON WELCH RN CRNA PC

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	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1558688812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MORTON WELCH RN CRNA PC

Provider Business Mailing Address
First Line	:	472 OAKLEY AVE
Second Line	:
City	:	ELMONT
State	:	NY
Zip	:	11003-3742
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1840 BROOKLYN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4240
Country	:	US
Telephone Number	:	718-236-1056
Fax Number	:	718-236-1055

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	LIZA CHOBRUTSKAYA
Credential	:
Telephone Number	:	718-236-1056

Provider Enumeration Date	:	04/27/2010
Last Update Date	:	04/27/2010

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