MEDICARE: MS. LAURIE BLEICH C.N.M.

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	367A00000X	Advanced Practice Midwife	F000035	NY

General Provider Information

NPI Number	:	1194819896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURIE BLEICH C.N.M.

Provider Business Mailing Address
First Line	:	6317 4TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-4922
Country	:	US
Telephone Number	:	718-907-8100
Fax Number	:	718-492-8614

Provider Business Practice Location Address
First Line	:	6317 4TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-4922
Country	:	US
Telephone Number	:	718-907-8100
Fax Number	:	718-492-8614

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	12/02/2011

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