MEDICARE: MS. MARTHA AMY CEDARHOLM NP

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	363LF0000X	Family Nurse Practitioner	F332185	NY

General Provider Information

NPI Number	:	1598987919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARTHA AMY CEDARHOLM NP

Provider Business Mailing Address
First Line	:	601 E 19TH ST
Second Line	:	APT 1G
City	:	BROOKLYN
State	:	NY
Zip	:	11226-7358
Country	:	US
Telephone Number	:	347-756-3497
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 WILLOUGHBY AVE
Second Line	:	SUITE 115
City	:	BROOKLYN
State	:	NY
Zip	:	11205-3818
Country	:	US
Telephone Number	:	718-399-4542
Fax Number	:	718-399-4544

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	07/08/2007

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