MEDICARE: MISS JILL VIRAG MSED

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1891075131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JILL VIRAG MSED

Provider Business Mailing Address
First Line	:	730 COLUMBUS AVE
Second Line	:	APARTMENT 6I
City	:	NEW YORK
State	:	NY
Zip	:	10025-6658
Country	:	US
Telephone Number	:	516-721-8745
Fax Number	:

Provider Business Practice Location Address
First Line	:	730 COLUMBUS AVE
Second Line	:	APARTMENT 6I
City	:	NEW YORK
State	:	NY
Zip	:	10025-6658
Country	:	US
Telephone Number	:	516-721-8745
Fax Number	:

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

Provider Enumeration Date	:	08/18/2011
Last Update Date	:	08/18/2011

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