MEDICARE: JENNIFER MORIN

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	163WG0000X	General Practice Registered Nurse	642383	NY

General Provider Information

NPI Number	:	1225446636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MORIN

Provider Business Mailing Address
First Line	:	PO BOX 656
Second Line	:
City	:	SPRING VALLEY
State	:	NY
Zip	:	10977-0656
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1070 HAVEMEYER AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-5310
Country	:	US
Telephone Number	:	718-863-6200
Fax Number	:

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

Provider Enumeration Date	:	07/29/2014
Last Update Date	:	07/29/2014

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