MEDICARE: MS. ELLEN J RAZGAITIS CNM

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	176B00000X	Midwife	001326	NY

General Provider Information

NPI Number	:	1881839462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELLEN J RAZGAITIS CNM

Provider Business Mailing Address
First Line	:	1622 8TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-5604
Country	:	US
Telephone Number	:	718-788-5796
Fax Number	:	718-788-5796

Provider Business Practice Location Address
First Line	:	1622 8TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-5604
Country	:	US
Telephone Number	:	718-788-5796
Fax Number	:	718-788-5796

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

Provider Enumeration Date	:	12/10/2008
Last Update Date	:	11/08/2010

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