MEDICARE: MS. LILLIAN A JONES

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	579743-1	NY

General Provider Information

NPI Number	:	1861755159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LILLIAN A JONES

Provider Business Mailing Address
First Line	:	211 DORADO COURT N
Second Line	:
City	:	MIDDLE ISLAND
State	:	NY
Zip	:	11953
Country	:	US
Telephone Number	:	631-775-7319
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 DORADO CT N
Second Line	:
City	:	MIDDLE ISLAND
State	:	NY
Zip	:	11953-1925
Country	:	US
Telephone Number	:	631-775-7319
Fax Number	:

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

Provider Enumeration Date	:	06/21/2012
Last Update Date	:	06/21/2012

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