Healthcare Provider Details

I. General information

NPI: 1205198868
Provider Name (Legal Business Name): DEPT. OF EDUCATION, NYC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 06/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 PROSPECT AVE RMJ122
BRONX NY
10457-3604
US

IV. Provider business mailing address

2875 BAINBRIDGE AVE APT. SUPT
BRONX NY
10458-2828
US

V. Phone/Fax

Practice location:
  • Phone: 718-933-5027
  • Fax:
Mailing address:
  • Phone: 646-784-8055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number440436
License Number StateNY

VIII. Authorized Official

Name: ANNA IRIZ MARIN
Title or Position: RN STAFF NURSE
Credential: RN
Phone: 718-933-5027