MEDICARE: NETWORK ADMIN LLC

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	213E00000X	Podiatrist

General Provider Information

NPI Number	:	1104362508
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NETWORK ADMIN LLC

Provider Business Mailing Address
First Line	:	PO BOX 190416
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-0416
Country	:	US
Telephone Number	:	800-272-5784
Fax Number	:

Provider Business Practice Location Address
First Line	:	1421 63RD ST
Second Line	:	1421A
City	:	BROOKLYN
State	:	NY
Zip	:	11219-5429
Country	:	US
Telephone Number	:	800-272-5784
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	SHELDON KOHL
Credential	:
Telephone Number	:	800-272-5784

Provider Enumeration Date	:	01/10/2017
Last Update Date	:	01/10/2017

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Directions to “NETWORK ADMIN LLC ” Practice Location

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