MEDICARE: MRS. HELENE H, C MICAHNIK RD, LDN

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	133V00000X	Registered Dietitian	DN003965	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821314691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HELENE H, C MICAHNIK RD, LDN

Provider Business Mailing Address
First Line	:	1710 BORBECK AVE APT 2
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-3515
Country	:	US
Telephone Number	:	215-742-1021
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 GRIFFITH ST APT 1
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-2932
Country	:	US
Telephone Number	:	215-742-1021
Fax Number	:

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

Provider Enumeration Date	:	04/19/2010
Last Update Date	:	01/29/2020

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