MEDICARE: NAOMI FRANCES AUSTIN

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	390200000X	Student in an Organized Health Care Education/Training Program

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396256814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAOMI FRANCES AUSTIN

Provider Business Mailing Address
First Line	:	1526 GRAND CONCOURSE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10457-8400
Country	:	US
Telephone Number	:	347-322-6994
Fax Number	:

Provider Business Practice Location Address
First Line	:	1526 GRAND CONCOURSE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10457-8400
Country	:	US
Telephone Number	:	718-282-3425
Fax Number	:

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

Provider Enumeration Date	:	10/24/2017
Last Update Date	:	10/24/2017

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