MEDICARE: IRENE ST.FIRMIN LPN

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	164W00000X	Licensed Practical Nurse	296261	NY

General Provider Information

NPI Number	:	1356897102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRENE ST.FIRMIN LPN

Provider Business Mailing Address
First Line	:	503 WEST 148TH STREET
Second Line	:	APT 51
City	:	NEW YORK
State	:	NY
Zip	:	10031-3734
Country	:	US
Telephone Number	:	929-227-0117
Fax Number	:

Provider Business Practice Location Address
First Line	:	2678 KINGSBRIDGE TER
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-7471
Country	:	US
Telephone Number	:	718-796-5800
Fax Number	:

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

Provider Enumeration Date	:	08/31/2016
Last Update Date	:	08/31/2016

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