MEDICARE: MARINA BETHELMY-STANISLAUS

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	000442

General Provider Information

NPI Number	:	1992929020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARINA BETHELMY-STANISLAUS

Provider Business Mailing Address
First Line	:	220 CHURCH ST FL 5
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10013-2904
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 CHURCH ST
Second Line	:	5TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10013-2904
Country	:	US
Telephone Number	:	646-619-6696
Fax Number	:

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

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	07/08/2007

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