MEDICARE: HELEN FUNDARO

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	378947	NY

General Provider Information

NPI Number	:	1154696110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HELEN FUNDARO

Provider Business Mailing Address
First Line	:	50 JEFFERSON ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-3964
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 JEFFERSON ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-3964
Country	:	US
Telephone Number	:	718-979-1030
Fax Number	:	718-979-0259

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

Provider Enumeration Date	:	03/09/2012
Last Update Date	:	03/09/2012

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Directions to “ HELEN FUNDARO ” Practice Location

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