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General NPI Number Information
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NPI Number | 1750943569
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Entity Type | Individual
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Provider Name | PETAGAYE MARSHALEE CHASE MS,SPECIAL EDUCATION
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Gender | Female
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Dates
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Enumeration Date | 07/01/2019
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Last Update Date | 07/01/2019
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Provider Practice Location Address
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Address Line | 139 NEWPORT ST APT 2F
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City | BROOKLYN
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State | NY
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Zip | 11212-5390
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Country | US
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Telephone | 631-805-9525
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 360070
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City | BROOKLYN
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State | NY
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Zip | 11236-0070
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Country | US
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Telephone | 631-805-9525
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1313099291
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1313092191
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1312574191
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1313962191
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License Number State | NY
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