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NPI Code Detail

MEDICARE: JACOB RIEDER L.M.S.W.

MEDICARE: JACOB RIEDER L.M.S.W.
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
1104100000XSocial Worker073895NY

General Provider Information

NPI Number : 1760577928
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB RIEDER L.M.S.W.
Provider Business Mailing Address
First Line : 1562 E 14TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11230-7104
Country : US
Telephone Number : 718-336-5533
Fax Number :
Provider Business Practice Location Address
First Line : 2020 CONEY ISLAND AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11223-2329
Country : US
Telephone Number : 718-676-4210
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2006
Last Update Date : 07/08/2007

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