MEDICARE: TERILEE WREN

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1104322684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERILEE WREN

Provider Business Mailing Address
First Line	:	254 S MAIN ST STE 400
Second Line	:
City	:	NEW CITY
State	:	NY
Zip	:	10956-3363
Country	:	US
Telephone Number	:	845-638-1592
Fax Number	:	845-638-1830

Provider Business Practice Location Address
First Line	:	254 S MAIN ST STE 400
Second Line	:
City	:	NEW CITY
State	:	NY
Zip	:	10956-3363
Country	:	US
Telephone Number	:	845-638-1592
Fax Number	:	845-638-1830

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

Provider Enumeration Date	:	04/03/2018
Last Update Date	:	04/03/2018

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Directions to “ TERILEE WREN ” Practice Location

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