MEDICARE: FALLON PIDCOCK CNM

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	176B00000X	Midwife	002168	NY

General Provider Information

NPI Number	:	1225756836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FALLON PIDCOCK CNM

Provider Business Mailing Address
First Line	:	317 W 93RD ST APT 5D
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-7236
Country	:	US
Telephone Number	:	508-733-3038
Fax Number	:

Provider Business Practice Location Address
First Line	:	371 STOCKHOLM ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11237-4194
Country	:	US
Telephone Number	:	718-508-4619
Fax Number	:

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

Provider Enumeration Date	:	08/19/2022
Last Update Date	:	08/19/2022

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