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NPI Code Detail

MEDICARE: MR. RUDOLPH E CHRISTMAS LPN

MEDICARE:  MR. RUDOLPH E CHRISTMAS  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
1164W00000XLicensed Practical Nurse210568NY

General Provider Information

NPI Number : 1538483011
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RUDOLPH E CHRISTMAS LPN
Provider Business Mailing Address
First Line : PO BOX 804
Second Line :
City : BRONX
State : NY
Zip : 10458-0703
Country : US
Telephone Number : 347-584-7038
Fax Number : 347-449-6324
Provider Business Practice Location Address
First Line : 3424 ELY AVE
Second Line :
City : BRONX
State : NY
Zip : 10469-2636
Country : US
Telephone Number : 347-584-7038
Fax Number : 347-449-6324
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2010
Last Update Date : 03/26/2010

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Directions to “ MR. RUDOLPH E CHRISTMAS LPN” Practice Location

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