MEDICARE: BAD NOODLE, LLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1871157396
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAD NOODLE, LLC

Provider Business Mailing Address
First Line	:	127 W 95TH ST APT 2
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-6639
Country	:	US
Telephone Number	:	347-443-9318
Fax Number	:

Provider Business Practice Location Address
First Line	:	865 W END AVE APT 1A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-8402
Country	:	US
Telephone Number	:	347-443-9318
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. MASHA BOROVIKOVA ARMYN
Credential	:	PHD
Telephone Number	:	347-443-9318

Provider Enumeration Date	:	04/30/2019
Last Update Date	:	04/30/2019

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Directions to “BAD NOODLE, LLC ” Practice Location

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