MEDICARE: NASIA NORDELUS

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	164X00000X	Licensed Vocational Nurse	316260	NY

General Provider Information

NPI Number	:	1720417769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NASIA NORDELUS

Provider Business Mailing Address
First Line	:	1865 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4840
Country	:	US
Telephone Number	:	516-444-2984
Fax Number	:

Provider Business Practice Location Address
First Line	:	1865 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4840
Country	:	US
Telephone Number	:	516-444-2984
Fax Number	:

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

Provider Enumeration Date	:	11/08/2013
Last Update Date	:	11/08/2013

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Directions to “ NASIA NORDELUS ” Practice Location

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