MEDICARE: MISS ROENA ASNETH PINTO LPN

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	264854	NY

General Provider Information

NPI Number	:	1134452709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ROENA ASNETH PINTO LPN

Provider Business Mailing Address
First Line	:	1031 E 221 ST
Second Line	:	FL 1
City	:	BRONX
State	:	NY
Zip	:	10469
Country	:	US
Telephone Number	:	718-655-5895
Fax Number	:	718-655-5895

Provider Business Practice Location Address
First Line	:	1031 E 221 ST
Second Line	:	FL 1
City	:	BRONX
State	:	NY
Zip	:	10469
Country	:	US
Telephone Number	:	718-655-5895
Fax Number	:	718-655-5895

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

Provider Enumeration Date	:	09/14/2009
Last Update Date	:	09/14/2009

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