MEDICARE: MR. TANOE SAM RN

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	695374-1	NY

General Provider Information

NPI Number	:	1013395656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TANOE SAM RN

Provider Business Mailing Address
First Line	:	4213 BYRON AVE
Second Line	:	APT F1
City	:	BRONX
State	:	NY
Zip	:	10466-3112
Country	:	US
Telephone Number	:	917-741-5920
Fax Number	:

Provider Business Practice Location Address
First Line	:	4213 BYRON AVE
Second Line	:	APT F1
City	:	BRONX
State	:	NY
Zip	:	10466-3112
Country	:	US
Telephone Number	:	917-741-5920
Fax Number	:

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

Provider Enumeration Date	:	05/15/2015
Last Update Date	:	05/15/2015

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