MEDICARE: MISS COLLEEN BOWMAN MSED (BIRTH-2 SPED)

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	252Y00000X	Early Intervention Provider Agency
2	252Y00000X	Early Intervention Provider Agency	342302406	NY

General Provider Information

NPI Number	:	1174928006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS COLLEEN BOWMAN MSED (BIRTH-2 SPED)

Provider Business Mailing Address
First Line	:	36 AUSTIN AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-4502
Country	:	US
Telephone Number	:	631-766-1992
Fax Number	:

Provider Business Practice Location Address
First Line	:	36 AUSTIN AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-4502
Country	:	US
Telephone Number	:	631-766-1992
Fax Number	:

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

Provider Enumeration Date	:	11/04/2014
Last Update Date	:	11/04/2014

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Directions to “ MISS COLLEEN BOWMAN MSED (BIRTH-2 SPED)” Practice Location

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