Healthcare Provider Details

I. General information

NPI: 1336229806
Provider Name (Legal Business Name): SHEILA L LOEB CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MMG - GRAND CONCOURSE 2532 GRAND CONCOURSE
BRONX NY
10458
US

IV. Provider business mailing address

1140 KENSINGTON RD
TEANECK NJ
07666-2758
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-1546
  • Fax:
Mailing address:
  • Phone: 718-960-1546
  • Fax: 718-960-2123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberF000268
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: