MEDICARE: SIMPLE NURSE PRACTITIONER IN FAMILY HEALTH PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207RC0000X	Cardiovascular Disease Physician
2	207RP1001X	Pulmonary Disease Physician
3	2085R0202X	Diagnostic Radiology Physician
4	364SF0001X	Family Health Clinical Nurse Specialist

General Provider Information

NPI Number	:	1821634130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMPLE NURSE PRACTITIONER IN FAMILY HEALTH PC

Provider Business Mailing Address
First Line	:	2327 83RD ST STE D
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-2749
Country	:	US
Telephone Number	:	718-252-4222
Fax Number	:

Provider Business Practice Location Address
First Line	:	2327 83RD ST STE D
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-2749
Country	:	US
Telephone Number	:	718-252-4222
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	IRENA HARTELL
Credential	:
Telephone Number	:	646-588-9560

Provider Enumeration Date	:	11/21/2019
Last Update Date	:	11/21/2019

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