MEDICARE: MR. GEORGE MICHAEL NORVILAS RN

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	26NO06123300	NJ

General Provider Information

NPI Number	:	1710961685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GEORGE MICHAEL NORVILAS RN

Provider Business Mailing Address
First Line	:	427 WILLOW AVE
Second Line	:
City	:	ROSELLE PARK
State	:	NJ
Zip	:	07204-1526
Country	:	US
Telephone Number	:	908-241-6488
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 S PARK AVE
Second Line	:
City	:	LINDEN
State	:	NJ
Zip	:	07036-1610
Country	:	US
Telephone Number	:	908-523-6290
Fax Number	:	908-523-5215

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

Provider Enumeration Date	:	12/02/2005
Last Update Date	:	07/08/2007

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