MEDICARE: MISS PAULA PAMELLA GILFILLIAN 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	318410-1	NY

General Provider Information

NPI Number	:	1740683986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS PAULA PAMELLA GILFILLIAN LPN

Provider Business Mailing Address
First Line	:	814 A TILDEN ST.
Second Line	:	APT 4D
City	:	BRONX
State	:	NY
Zip	:	10467
Country	:	US
Telephone Number	:	347-595-4572
Fax Number	:

Provider Business Practice Location Address
First Line	:	814 TILDEN ST # A
Second Line	:	APT 4D
City	:	BRONX
State	:	NY
Zip	:	10467-6027
Country	:	US
Telephone Number	:	347-595-4572
Fax Number	:

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

Provider Enumeration Date	:	10/02/2014
Last Update Date	:	10/02/2014

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