MEDICARE: MANAL ABDELAZIZ

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	172V00000X	Community Health Worker	009490	NY

General Provider Information

NPI Number	:	1356894216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANAL ABDELAZIZ

Provider Business Mailing Address
First Line	:	7025 3RD AVE
Second Line	:	4D
City	:	BROOKLYN
State	:	NY
Zip	:	11209
Country	:	US
Telephone Number	:	718-663-1842
Fax Number	:

Provider Business Practice Location Address
First Line	:	7105 3RD AVE
Second Line	:	PMB 238
City	:	BROOKLYN
State	:	NY
Zip	:	11209-1308
Country	:	US
Telephone Number	:	718-663-1842
Fax Number	:

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

Provider Enumeration Date	:	07/27/2016
Last Update Date	:	07/27/2016

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