MEDICARE: LEAH FREEDMAN M.S.

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	252Y00000X	Early Intervention Provider Agency	524293111	NY

General Provider Information

NPI Number	:	1982959748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH FREEDMAN M.S.

Provider Business Mailing Address
First Line	:	2600 NETHERLAND AVE.
Second Line	:	APT. 1212
City	:	BRONX
State	:	NY
Zip	:	10463-4837
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 NETHERLAND AVE.
Second Line	:	APT. 1212
City	:	BRONX
State	:	NY
Zip	:	10463-4837
Country	:	US
Telephone Number	:	171-837-7883
Fax Number	:

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

Provider Enumeration Date	:	07/18/2012
Last Update Date	:	07/18/2012

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