MEDICARE: MRS. ELAINE M TRENTACOSTA 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	464769	NY

General Provider Information

NPI Number	:	1205091436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELAINE M TRENTACOSTA RN

Provider Business Mailing Address
First Line	:	91-31 QUEENS BLVD.
Second Line	:
City	:	ELMHURST
State	:	NY
Zip	:	11373
Country	:	US
Telephone Number	:	718-779-7000
Fax Number	:	718-458-5379

Provider Business Practice Location Address
First Line	:	1240 BROADCAST PLZ
Second Line	:
City	:	MERRICK
State	:	NY
Zip	:	11566-3461
Country	:	US
Telephone Number	:	516-546-8000
Fax Number	:	516-868-7394

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

Provider Enumeration Date	:	07/28/2008
Last Update Date	:	11/01/2013

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