MEDICARE: THERESA M PAYESKO 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	163WH0200X	Home Health Registered Nurse	26NO08847700	NJ

General Provider Information

NPI Number	:	1376660928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA M PAYESKO RN

Provider Business Mailing Address
First Line	:	39 RANDOLPH RD
Second Line	:
City	:	FREEHOLD
State	:	NJ
Zip	:	07728-1531
Country	:	US
Telephone Number	:	908-896-4740
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 E 2ND ST LOWR LEVEL
Second Line	:
City	:	SCOTCH PLAINS
State	:	NJ
Zip	:	07076-1749
Country	:	US
Telephone Number	:	908-322-8883
Fax Number	:

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/08/2007

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