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NPI Code Detail

MEDICARE: SERITA D ADJIN LPN

MEDICARE:   SERITA D ADJIN  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
1164W00000XLicensed Practical Nurse301105NY

General Provider Information

NPI Number : 1851602130
Entity Type Code : Individual
Provider Name (Legal Business Name) : SERITA D ADJIN LPN
Provider Business Mailing Address
First Line : 48 NEW TURNPIKE RD
Second Line :
City : TROY
State : NY
Zip : 12182-1412
Country : US
Telephone Number : 518-961-0656
Fax Number :
Provider Business Practice Location Address
First Line : 48 NEW TURNPIKE RD
Second Line :
City : TROY
State : NY
Zip : 12182-1412
Country : US
Telephone Number : 518-961-0656
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2010
Last Update Date : 07/01/2010

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