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General NPI Number Information
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NPI Number | 1801277827
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Entity Type | Individual
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Provider Name | MEGAN WAHRENDORF
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Gender | Female
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Dates
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Enumeration Date | 06/16/2015
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Last Update Date | 06/16/2015
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Provider Practice Location Address
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Address Line | 1495 E 28TH ST APT 9A
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City | BROOKLYN
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State | NY
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Zip | 11229-1801
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Country | US
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Telephone | 917-667-6617
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Fax |
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Provider Business Mailing Address
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Address Line | 1495 E 28TH ST APT 9A
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City | BROOKLYN
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State | NY
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Zip | 11229-1801
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Country | US
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Telephone | 917-667-6617
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1218712
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License Number State | NY
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