MEDICARE: SUSAN WAGNER DAY SCHOOLS

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	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1003243015
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSAN WAGNER DAY SCHOOLS

Provider Business Mailing Address
First Line	:	4102 WHITE PLAINS RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-3008
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4102 WHITE PLAINS RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-3008
Country	:	US
Telephone Number	:	718-547-0501
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	JOYCE JAMES
Credential	:
Telephone Number	:	718-547-0501

Provider Enumeration Date	:	10/04/2013
Last Update Date	:	10/04/2013

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