MEDICARE: DANIELLE 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	347C00000X	Private Vehicle
2	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1790037919
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANIELLE GERMAIN

Provider Business Mailing Address
First Line	:	3299 HARBOR POINT RD
Second Line	:
City	:	BALDWIN
State	:	NY
Zip	:	11510-5140
Country	:	US
Telephone Number	:	516-652-0578
Fax Number	:	718-821-5009

Provider Business Practice Location Address
First Line	:	3299 HARBOR POINT RD
Second Line	:
City	:	BALDWIN
State	:	NY
Zip	:	11510-5140
Country	:	US
Telephone Number	:	516-652-0578
Fax Number	:	718-821-5009

Authorized Official
Title or Position	:	MANAGEMENT
Name	:	DANIELLE GERMAIN
Credential	:	AAS IN ACCOUNTING
Telephone Number	:	516-652-0578

Provider Enumeration Date	:	10/11/2012
Last Update Date	:	10/11/2012

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