MEDICARE: MS. NICOLE PANTOPOULOS MS ED/SPECIAL EDU

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

General Provider Information

NPI Number	:	1427406008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NICOLE PANTOPOULOS MS ED/SPECIAL EDU

Provider Business Mailing Address
First Line	:	845 E 96TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-2105
Country	:	US
Telephone Number	:	646-379-1778
Fax Number	:

Provider Business Practice Location Address
First Line	:	845 E 96TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-2105
Country	:	US
Telephone Number	:	646-379-1778
Fax Number	:

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

Provider Enumeration Date	:	05/24/2016
Last Update Date	:	06/13/2016

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