MEDICARE: MISS MARISA ANNA ALBIAN

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

General Provider Information

NPI Number	:	1013349828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MARISA ANNA ALBIAN

Provider Business Mailing Address
First Line	:	32 WHITMAN DRIVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234
Country	:	US
Telephone Number	:	646-418-2062
Fax Number	:

Provider Business Practice Location Address
First Line	:	32 WHITMAN DR
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-6703
Country	:	US
Telephone Number	:	646-418-2062
Fax Number	:

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

Provider Enumeration Date	:	08/02/2013
Last Update Date	:	08/02/2013

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Directions to “ MISS MARISA ANNA ALBIAN ” Practice Location

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