MEDICARE: MIZANE STAFFING, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	251E00000X	Home Health Agency	NJ
2	253Z00000X	In Home Supportive Care Agency	NJ
3	251J00000X	Nursing Care Agency	NJ

General Provider Information

NPI Number	:	1386939064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIZANE STAFFING, INC.

Provider Business Mailing Address
First Line	:	191 NORTH AVE. STE. 205
Second Line	:
City	:	DUNELLEN
State	:	NJ
Zip	:	08812
Country	:	US
Telephone Number	:	908-769-0462
Fax Number	:	908-757-6005

Provider Business Practice Location Address
First Line	:	191 NORTH AVE STE 205
Second Line	:
City	:	DUNELLEN
State	:	NJ
Zip	:	08812-1277
Country	:	US
Telephone Number	:	908-769-0462
Fax Number	:	908-757-6005

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. MYRNA M ROBERTS
Credential	:
Telephone Number	:	908-769-0462

Provider Enumeration Date	:	06/10/2011
Last Update Date	:	06/10/2011

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