MEDICARE: MR. STAFFORD MALCUS MCISAACS SR. R.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	163W00000X	Registered Nurse	418032-1	NY

General Provider Information

NPI Number	:	1215105945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STAFFORD MALCUS MCISAACS SR. R.N.,

Provider Business Mailing Address
First Line	:	2 SCOTTO FARM LN
Second Line	:	MILLSTONE
City	:	MILLSTONE TOWNSHIP
State	:	NJ
Zip	:	08535-9426
Country	:	US
Telephone Number	:	732-446-8494
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 SCOTTO FARM LN
Second Line	:	MILLSTONE
City	:	MILLSTONE TOWNSHIP
State	:	NJ
Zip	:	08535-9426
Country	:	US
Telephone Number	:	732-446-8494
Fax Number	:

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

Provider Enumeration Date	:	02/15/2008
Last Update Date	:	12/14/2010

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