MEDICARE: MR. ERNESTO MURRAY

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	3747A0650X	Attendant Care Provider

General Provider Information

NPI Number	:	1578196549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ERNESTO MURRAY

Provider Business Mailing Address
First Line	:	463 EAST 178ST APT#3B
Second Line	:
City	:	BRONX NEW YORK
State	:	NY
Zip	:	10457
Country	:	US
Telephone Number	:	785-787-2558
Fax Number	:

Provider Business Practice Location Address
First Line	:	463 EAST 178ST APT#3B
Second Line	:
City	:	BRONX NEW YORK
State	:	NY
Zip	:	10457
Country	:	US
Telephone Number	:	785-787-2558
Fax Number	:

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

Provider Enumeration Date	:	02/19/2020
Last Update Date	:	02/19/2020

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