MEDICARE: DR. DJENANE BARTHOLOMEW RN

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	523142-1	NY
2	363LA2200X	Adult Health Nurse Practitioner	F310460-01	NY
3	163WH0200X	Home Health Registered Nurse	26NR13685400	NJ

General Provider Information

NPI Number	:	1255582599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DJENANE BARTHOLOMEW RN

Provider Business Mailing Address
First Line	:	23 DORA LN
Second Line	:
City	:	HOLMDEL
State	:	NJ
Zip	:	07733-1624
Country	:	US
Telephone Number	:	732-888-1355
Fax Number	:	732-888-1639

Provider Business Practice Location Address
First Line	:	517 53RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-2736
Country	:	US
Telephone Number	:	516-852-2463
Fax Number	:

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

Provider Enumeration Date	:	10/06/2008
Last Update Date	:	10/07/2021

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