MEDICARE: EDY NATHAN LCSWR, CST

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	1041C0700X	Clinical Social Worker	048055	NY

General Provider Information

NPI Number	:	1437371911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDY NATHAN LCSWR, CST

Provider Business Mailing Address
First Line	:	360 W 34TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10001-2403
Country	:	US
Telephone Number	:	917-757-3516
Fax Number	:

Provider Business Practice Location Address
First Line	:	360 W 34TH ST
Second Line	:	3G
City	:	NEW YORK
State	:	NY
Zip	:	10001-2403
Country	:	US
Telephone Number	:	917-757-3516
Fax Number	:

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	01/18/2016

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