MEDICARE: MR. BRYCE J PROPSER MSW CPHT

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	251S00000X	Community/Behavioral Health Agency
2	183700000X	Pharmacy Technician	300100104111250	NY

General Provider Information

NPI Number	:	1881730679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRYCE J PROPSER MSW CPHT

Provider Business Mailing Address
First Line	:	12826 INWOOD ST
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11436-1827
Country	:	US
Telephone Number	:	917-217-0079
Fax Number	:

Provider Business Practice Location Address
First Line	:	858 E 29TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-2927
Country	:	US
Telephone Number	:	718-859-4500
Fax Number	:

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	01/23/2019

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