MEDICARE: TAMARA NEMSADZE

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

General Provider Information

NPI Number	:	1780066563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA NEMSADZE

Provider Business Mailing Address
First Line	:	1205 AVENUE R APT 1G
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1029
Country	:	US
Telephone Number	:	347-898-1736
Fax Number	:

Provider Business Practice Location Address
First Line	:	1205 AVENUE R APT 1G
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1029
Country	:	US
Telephone Number	:	347-898-1736
Fax Number	:

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

Provider Enumeration Date	:	06/29/2015
Last Update Date	:	03/20/2026

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