MEDICARE: GLENN WURTZEL MS, NP-P, APRN-BC

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	163W00000X	Registered Nurse	517707	NY
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	400680	NY

General Provider Information

NPI Number	:	1831188424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENN WURTZEL MS, NP-P, APRN-BC

Provider Business Mailing Address
First Line	:	140 RIVERSIDE DR
Second Line	:	SUITE 1-O
City	:	NEW YORK
State	:	NY
Zip	:	10024-2605
Country	:	US
Telephone Number	:	212-988-4704
Fax Number	:	212-988-4706

Provider Business Practice Location Address
First Line	:	140 RIVERSIDE DR
Second Line	:	SUITE 1-O
City	:	NEW YORK
State	:	NY
Zip	:	10024-2605
Country	:	US
Telephone Number	:	212-988-4704
Fax Number	:	212-988-4706

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

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	04/03/2015

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