MEDICARE: JANICE MORDI PMHNP

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	163W00000X	Registered Nurse	636528	NY
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	402350	NY

General Provider Information

NPI Number	:	1831499854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE MORDI PMHNP

Provider Business Mailing Address
First Line	:	191 JORALEMON ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-4306
Country	:	US
Telephone Number	:	718-722-6001
Fax Number	:

Provider Business Practice Location Address
First Line	:	191 JORALEMON ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-4306
Country	:	US
Telephone Number	:	718-722-6190
Fax Number	:	718-722-6189

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

Provider Enumeration Date	:	10/25/2010
Last Update Date	:	03/17/2018

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