MEDICARE: MS. SHELLEY BROOK PERLINE DC

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	111N00000X	Chiropractor	X0100851	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	X6V56	OTHER	NY	EMPIRE BCBS
2	P3006366	OTHER	NY	OXFORD

General Provider Information

NPI Number	:	1225198898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHELLEY BROOK PERLINE DC

Provider Business Mailing Address
First Line	:	920 3RD AVE
Second Line	:	6TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10022-3627
Country	:	US
Telephone Number	:	212-371-0700
Fax Number	:	212-750-9114

Provider Business Practice Location Address
First Line	:	920 3RD AVE
Second Line	:	6TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10022-3627
Country	:	US
Telephone Number	:	212-371-0700
Fax Number	:	212-750-9114

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

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	12/05/2016

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Directions to “ MS. SHELLEY BROOK PERLINE DC” Practice Location

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