MEDICARE: MISS JUSTINE M CERTO 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	695414-1	NY

General Provider Information

NPI Number	:	1457745853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JUSTINE M CERTO RN

Provider Business Mailing Address
First Line	:	10 SCOTT DR
Second Line	:
City	:	MONROE TWP
State	:	NJ
Zip	:	08831-3543
Country	:	US
Telephone Number	:	917-207-6349
Fax Number	:	718-431-8709

Provider Business Practice Location Address
First Line	:	10 SCOTT DR
Second Line	:
City	:	MONROE TWP
State	:	NJ
Zip	:	08831-3543
Country	:	US
Telephone Number	:	917-207-6349
Fax Number	:	718-431-8709

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

Provider Enumeration Date	:	03/24/2015
Last Update Date	:	03/24/2015

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