MEDICARE: MALIYA KASIMU 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
1	164W00000X	Licensed Practical Nurse	349775	NY

General Provider Information

NPI Number	:	1710710025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALIYA KASIMU LPN

Provider Business Mailing Address
First Line	:	450 E 169TH STREET
Second Line	:	APT 7B
City	:	BRONX
State	:	NY
Zip	:	10456-2642
Country	:	US
Telephone Number	:	917-862-5215
Fax Number	:	718-347-4643

Provider Business Practice Location Address
First Line	:	450 E 169TH STREET
Second Line	:	APT 7B
City	:	BRONX
State	:	NY
Zip	:	10456-2642
Country	:	US
Telephone Number	:	917-862-5215
Fax Number	:	718-347-4643

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

Provider Enumeration Date	:	08/22/2024
Last Update Date	:	08/22/2024

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