MEDICARE: JUDITH C. PARA R.N.

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	516173	NY

General Provider Information

NPI Number	:	1508066762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH C. PARA R.N.

Provider Business Mailing Address
First Line	:	1533 LOUIS KOSSUTH AVE
Second Line	:
City	:	BOHEMIA
State	:	NY
Zip	:	11716-1509
Country	:	US
Telephone Number	:	631-589-3998
Fax Number	:

Provider Business Practice Location Address
First Line	:	1533 LOUIS KOSSUTH AVE
Second Line	:
City	:	BOHEMIA
State	:	NY
Zip	:	11716-1509
Country	:	US
Telephone Number	:	631-589-3998
Fax Number	:

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

Provider Enumeration Date	:	07/24/2007
Last Update Date	:	07/24/2007

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