MEDICARE: ISAMAR BRYAN CM

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	367A00000X	Advanced Practice Midwife	001929	NY

General Provider Information

NPI Number	:	1679134258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISAMAR BRYAN CM

Provider Business Mailing Address
First Line	:	68 E 131ST ST STE 100
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10037-2905
Country	:	US
Telephone Number	:	212-281-8600
Fax Number	:

Provider Business Practice Location Address
First Line	:	68 E 131ST ST STE 100
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10037-2905
Country	:	US
Telephone Number	:	212-281-8600
Fax Number	:

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

Provider Enumeration Date	:	06/25/2019
Last Update Date	:	04/13/2020

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Directions to “ ISAMAR BRYAN CM” Practice Location

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