Provider Demographics
NPI:1891930848
Name:MOMO, BERNICE SCHOFFNER (RN)
Entity Type:Individual
Prefix:MRS
First Name:BERNICE
Middle Name:SCHOFFNER
Last Name:MOMO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:BERNICE
Other - Middle Name:COOPER
Other - Last Name:SCHOFFNER-MOMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:P.O. BOX 140882
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-0882
Mailing Address - Country:US
Mailing Address - Phone:718-619-5956
Mailing Address - Fax:718-442-3683
Practice Address - Street 1:88 PARKHILL LANE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-3638
Practice Address - Country:US
Practice Address - Phone:718-442-3683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY511664-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse