MEDICARE: MRS. BARBARA MICHELLE MEZRAHI

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	174400000X	Specialist	720183131	NY

General Provider Information

NPI Number	:	1821422288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BARBARA MICHELLE MEZRAHI

Provider Business Mailing Address
First Line	:	128 DUBOIS AVE
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11581-3335
Country	:	US
Telephone Number	:	516-859-7125
Fax Number	:

Provider Business Practice Location Address
First Line	:	128 DUBOIS AVE
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11581-3335
Country	:	US
Telephone Number	:	516-859-7125
Fax Number	:

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

Provider Enumeration Date	:	08/21/2013
Last Update Date	:	08/21/2013

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