MEDICARE: JAMES GEORGE

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	3088441	NY

General Provider Information

NPI Number	:	1972846442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES GEORGE

Provider Business Mailing Address
First Line	:	145 GREEN KNOLLS DR APT D
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14620-4832
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 GREEN KNOLLS DR APT D
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14620-4832
Country	:	US
Telephone Number	:	585-415-9674
Fax Number	:

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

Provider Enumeration Date	:	04/02/2013
Last Update Date	:	04/02/2013

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