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NPI Code Detail

MEDICARE: JUSTICE WARREN

MEDICARE: JUSTICE WARREN
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
1164W00000XLicensed Practical Nurse349938NY

General Provider Information

NPI Number : 1790529089
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTICE WARREN
Provider Business Mailing Address
First Line : 920 PROSPECT AVE APT 5D
Second Line :
City : BRONX
State : NY
Zip : 10459-3968
Country : US
Telephone Number : 646-544-1007
Fax Number :
Provider Business Practice Location Address
First Line : 1115 AVENUE U
Second Line :
City : BROOKLYN
State : NY
Zip : 11223-5019
Country : US
Telephone Number : 718-717-8337
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2024
Last Update Date : 06/21/2024

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Directions to “ JUSTICE WARREN ” Practice Location

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