MEDICARE: MORIAH JEANNE TORRES 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	163WC1500X	Community Health Registered Nurse	578473-1	NY

General Provider Information

NPI Number	:	1245424183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MORIAH JEANNE TORRES R.N.

Provider Business Mailing Address
First Line	:	3 COBB LN
Second Line	:
City	:	MEDFORD
State	:	NY
Zip	:	11763-4300
Country	:	US
Telephone Number	:	631-803-2608
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 COBB LN
Second Line	:
City	:	MEDFORD
State	:	NY
Zip	:	11763-4300
Country	:	US
Telephone Number	:	631-803-2608
Fax Number	:

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

Provider Enumeration Date	:	09/04/2007
Last Update Date	:	09/04/2007

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