MEDICARE: MRS. RUBY MARCIA WACHTEL NURSE PRACTITIONER

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	363L00000X	Nurse Practitioner	301240	NY

General Provider Information

NPI Number	:	1861719700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RUBY MARCIA WACHTEL NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	100 BAKER CT UNIT 5
Second Line	:
City	:	ISLAND PARK
State	:	NY
Zip	:	11558-2260
Country	:	US
Telephone Number	:	516-431-7714
Fax Number	:

Provider Business Practice Location Address
First Line	:	471 HART ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-2515
Country	:	US
Telephone Number	:	718-443-3800
Fax Number	:	718-443-3837

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

Provider Enumeration Date	:	05/03/2010
Last Update Date	:	05/03/2010

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