MEDICARE: RUTH A MITSEL

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	171M00000X	Case Manager/Care Coordinator		NY

General Provider Information

NPI Number	:	1255816971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH A MITSEL

Provider Business Mailing Address
First Line	:	7515 AVENUE W
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-6609
Country	:	US
Telephone Number	:	917-577-7753
Fax Number	:

Provider Business Practice Location Address
First Line	:	4117 AVENUE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5119
Country	:	US
Telephone Number	:	917-304-1328
Fax Number	:

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

Provider Enumeration Date	:	09/27/2018
Last Update Date	:	09/27/2018

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Directions to “ RUTH A MITSEL ” Practice Location

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