MEDICARE: MARY JUDY DESINOR-VERNON 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	7701175-01	NY

General Provider Information

NPI Number	:	1356297113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY JUDY DESINOR-VERNON RN

Provider Business Mailing Address
First Line	:	2940 OCEAN PKWY APT 7P
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-8221
Country	:	US
Telephone Number	:	225-892-3275
Fax Number	:

Provider Business Practice Location Address
First Line	:	22121 JAMAICA AVE FL 2
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11428-2015
Country	:	US
Telephone Number	:	225-892-3275
Fax Number	:

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

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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