MEDICARE: MS. ROSLYN MEDOFF-RIVERA 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	2623431	NY

General Provider Information

NPI Number	:	1730444878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROSLYN MEDOFF-RIVERA LPN

Provider Business Mailing Address
First Line	:	68 SCHERMERHORN ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-5005
Country	:	US
Telephone Number	:	718-858-7200
Fax Number	:

Provider Business Practice Location Address
First Line	:	68 SCHERMERHORN ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-5005
Country	:	US
Telephone Number	:	718-858-7200
Fax Number	:

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

Provider Enumeration Date	:	07/04/2012
Last Update Date	:	07/04/2012

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