MEDICARE: MS. DENNIES BEVERLY SAMUELS

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	664267	NY

General Provider Information

NPI Number	:	1932451986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DENNIES BEVERLY SAMUELS

Provider Business Mailing Address
First Line	:	180 HERZL ST FL 3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11212-4631
Country	:	US
Telephone Number	:	718-600-0118
Fax Number	:

Provider Business Practice Location Address
First Line	:	180 HERZL ST FL 3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11212-4631
Country	:	US
Telephone Number	:	718-600-0118
Fax Number	:

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

Provider Enumeration Date	:	10/15/2012
Last Update Date	:	10/15/2012

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