MEDICARE: MRS. KAREN ANN BRADY L.P.N.

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	265197-1	NY

General Provider Information

NPI Number	:	1770866014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAREN ANN BRADY L.P.N.

Provider Business Mailing Address
First Line	:	32 ARBUTUS LN
Second Line	:
City	:	CORAM
State	:	NY
Zip	:	11727-3125
Country	:	US
Telephone Number	:	631-736-6826
Fax Number	:	631-736-9097

Provider Business Practice Location Address
First Line	:	3035 THOMSON AVE
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-3003
Country	:	US
Telephone Number	:	718-392-3999
Fax Number	:	718-784-4564

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

Provider Enumeration Date	:	09/22/2011
Last Update Date	:	09/22/2011

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