MEDICARE: FALILATU MOHAMMED

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	335421	NY

General Provider Information

NPI Number	:	1396385738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FALILATU MOHAMMED

Provider Business Mailing Address
First Line	:	2315 2ND AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10035-4160
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2315 2ND AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10035-4160
Country	:	US
Telephone Number	:	718-828-2666
Fax Number	:

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

Provider Enumeration Date	:	01/14/2020
Last Update Date	:	01/14/2020

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