MEDICARE: HAMDAM RABIEZADEH 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	192420	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	192420	OTHER	NY	NYS NURSING LICENSE

General Provider Information

NPI Number	:	1821243130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAMDAM RABIEZADEH LPN

Provider Business Mailing Address
First Line	:	18 FRANKLIN PL
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11023-1229
Country	:	US
Telephone Number	:	516-773-6388
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 FRANKLIN PL
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11023-1229
Country	:	US
Telephone Number	:	516-773-6388
Fax Number	:

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

Provider Enumeration Date	:	12/01/2008
Last Update Date	:	12/01/2008

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