MEDICARE: JUBRIL TOLANI PEDRO JR. L.P.N/L.M.T

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	295254	NY
2	225700000X	Massage Therapist	021140	NY

General Provider Information

NPI Number	:	1831490069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUBRIL TOLANI PEDRO JR. L.P.N/L.M.T

Provider Business Mailing Address
First Line	:	3102 ELMWOOD AVE
Second Line	:	APT.11
City	:	ROCHESTER
State	:	NY
Zip	:	14618-2018
Country	:	US
Telephone Number	:	585-957-5839
Fax Number	:

Provider Business Practice Location Address
First Line	:	3102 ELMWOOD AVE
Second Line	:	APT.11
City	:	ROCHESTER
State	:	NY
Zip	:	14618-2018
Country	:	US
Telephone Number	:	585-957-5839
Fax Number	:

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

Provider Enumeration Date	:	11/04/2010
Last Update Date	:	11/04/2010

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