MEDICARE: SUZZENY DELROSE PRINCE

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	203555-1	NY

General Provider Information

NPI Number	:	1447404728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZZENY DELROSE PRINCE

Provider Business Mailing Address
First Line	:	3515 EASTCHESTER RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-1670
Country	:	US
Telephone Number	:	718-944-1776
Fax Number	:	718-944-1779

Provider Business Practice Location Address
First Line	:	3515 EASTCHESTER RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-1670
Country	:	US
Telephone Number	:	718-944-1776
Fax Number	:	718-944-1779

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

Provider Enumeration Date	:	11/12/2008
Last Update Date	:	11/12/2008

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