MEDICARE: CORI LEE JERIN L.P.N.

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	232524-1	NY

General Provider Information

NPI Number	:	1528345238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORI LEE JERIN L.P.N.

Provider Business Mailing Address
First Line	:	115 POWERHOUSE RD
Second Line	:
City	:	LITTLE FALLS
State	:	NY
Zip	:	13365-3544
Country	:	US
Telephone Number	:	315-823-4388
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 POWERHOUSE RD
Second Line	:
City	:	LITTLE FALLS
State	:	NY
Zip	:	13365-3544
Country	:	US
Telephone Number	:	315-823-4388
Fax Number	:

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

Provider Enumeration Date	:	11/09/2011
Last Update Date	:	02/28/2017

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