MEDICARE: MS. RODELINE JASMIN

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	3005981	NY

General Provider Information

NPI Number	:	1740506112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RODELINE JASMIN

Provider Business Mailing Address
First Line	:	2902 CORTELYOU RD # A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-6374
Country	:	US
Telephone Number	:	718-287-4300
Fax Number	:	718-287-4600

Provider Business Practice Location Address
First Line	:	2902 CORTELYOU RD # A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-6374
Country	:	US
Telephone Number	:	718-287-4300
Fax Number	:	718-287-4600

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

Provider Enumeration Date	:	04/10/2010
Last Update Date	:	04/10/2010

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