MEDICARE: ROOTHCHILD ST GERMAIN

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	163WG0000X	General Practice Registered Nurse	676482-1	NY

General Provider Information

NPI Number	:	1588021513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROOTHCHILD ST GERMAIN

Provider Business Mailing Address
First Line	:	270 CROWN ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-2356
Country	:	US
Telephone Number	:	347-461-8366
Fax Number	:

Provider Business Practice Location Address
First Line	:	270 CROWN ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-2356
Country	:	US
Telephone Number	:	347-461-8366
Fax Number	:

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

Provider Enumeration Date	:	01/21/2016
Last Update Date	:	01/21/2016

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Directions to “ ROOTHCHILD ST GERMAIN ” Practice Location

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