MEDICARE: MRS. SANDRA SUSAN BLOCK-EFFRON

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	374T00000X	Religious Nonmedical Nursing Personnel
2	376G00000X	Nursing Home Administrator

General Provider Information

NPI Number	:	1154679728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SANDRA SUSAN BLOCK-EFFRON

Provider Business Mailing Address
First Line	:	5959 INDEPENDENCE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10471-1222
Country	:	US
Telephone Number	:	718-796-4200
Fax Number	:	718-549-3465

Provider Business Practice Location Address
First Line	:	5959 INDEPENDENCE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10471-1222
Country	:	US
Telephone Number	:	718-796-4200
Fax Number	:	718-549-3465

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

Provider Enumeration Date	:	08/29/2012
Last Update Date	:	08/29/2012

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