MEDICARE: MICHELLE NG

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		NY

General Provider Information

NPI Number	:	1447854534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE NG

Provider Business Mailing Address
First Line	:	938 E 15TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-3704
Country	:	US
Telephone Number	:	917-715-6598
Fax Number	:

Provider Business Practice Location Address
First Line	:	319 MELROSE ST APT 1B
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11237-1839
Country	:	US
Telephone Number	:	917-715-6598
Fax Number	:

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

Provider Enumeration Date	:	11/30/2020
Last Update Date	:	11/30/2020

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