MEDICARE: MRS. ELVIRA AKDAS MS

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	16123	NY

General Provider Information

NPI Number	:	1568726107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELVIRA AKDAS MS

Provider Business Mailing Address
First Line	:	6223 69TH PL
Second Line	:
City	:	MIDDLE VILLAGE
State	:	NY
Zip	:	11379-1107
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 CONEY ISLAND AVE STE 4
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-2343
Country	:	US
Telephone Number	:	718-434-1012
Fax Number	:	718-434-1088

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

Provider Enumeration Date	:	06/28/2012
Last Update Date	:	06/28/2012

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