MEDICARE: MR. NAPOLEON LOPEZ LAURITO V 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	200590-1	NY

General Provider Information

NPI Number	:	1841743168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NAPOLEON LOPEZ LAURITO V LPN

Provider Business Mailing Address
First Line	:	55 AUSTIN PL
Second Line	:	APPARTMENT 1 S
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-2141
Country	:	US
Telephone Number	:	551-697-9771
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 AUSTIN PL
Second Line	:	APPARTMENT 1 S
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-2141
Country	:	US
Telephone Number	:	551-697-9771
Fax Number	:

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

Provider Enumeration Date	:	08/03/2016
Last Update Date	:	08/03/2016

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