MEDICARE: MS. RUTH CALLAHAN PCD

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	374J00000X	Doula

General Provider Information

NPI Number	:	1366771495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RUTH CALLAHAN PCD

Provider Business Mailing Address
First Line	:	70 W 93RD ST
Second Line	:	# 20G
City	:	NEW YORK
State	:	NY
Zip	:	10025-7620
Country	:	US
Telephone Number	:	212-749-6613
Fax Number	:

Provider Business Practice Location Address
First Line	:	70 W 93RD ST
Second Line	:	# 20G
City	:	NEW YORK
State	:	NY
Zip	:	10025-7620
Country	:	US
Telephone Number	:	212-749-6613
Fax Number	:

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

Provider Enumeration Date	:	12/20/2009
Last Update Date	:	12/20/2009

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