MEDICARE: MISS MARY DESKOVICH R.N.

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	460125-1	NY

General Provider Information

NPI Number	:	1003181991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MARY DESKOVICH R.N.

Provider Business Mailing Address
First Line	:	21 JUMEL PL
Second Line	:	ROOM A132
City	:	NEW YORK
State	:	NY
Zip	:	10032-4316
Country	:	US
Telephone Number	:	212-342-2501
Fax Number	:	212-781-3985

Provider Business Practice Location Address
First Line	:	21 JUMEL PL
Second Line	:	ROOM A132
City	:	NEW YORK
State	:	NY
Zip	:	10032-4316
Country	:	US
Telephone Number	:	212-342-2501
Fax Number	:	212-781-3985

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

Provider Enumeration Date	:	03/12/2012
Last Update Date	:	03/12/2012

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