MEDICARE: MS. LISA VALENCIA JOSEPH LPN

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	164W00000X	Licensed Practical Nurse	2762571	NY
2	163WH0200X	Home Health Registered Nurse	745211-01	NY

General Provider Information

NPI Number	:	1265615926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA VALENCIA JOSEPH LPN

Provider Business Mailing Address
First Line	:	70 LINDEN BLVD APT 5F
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-3162
Country	:	US
Telephone Number	:	845-275-4984
Fax Number	:

Provider Business Practice Location Address
First Line	:	6424 18TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-3729
Country	:	US
Telephone Number	:	212-687-7464
Fax Number	:

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

Provider Enumeration Date	:	12/17/2007
Last Update Date	:	10/09/2024

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