MEDICARE: TAVERAS CHILD DEVELOPMENT SERVICES INC

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

General Provider Information

NPI Number	:	1013567858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAVERAS CHILD DEVELOPMENT SERVICES INC

Provider Business Mailing Address
First Line	:	2200 CEDAR AVE APT 1
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10468-5521
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 CEDAR AVE APT 1
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10468-5521
Country	:	US
Telephone Number	:	646-221-1251
Fax Number	:

Authorized Official
Title or Position	:	SPECIAL EDUCATION TEACHER
Name	:	ELIZABETH TAVERAS
Credential	:	MS ED
Telephone Number	:	646-221-1251

Provider Enumeration Date	:	09/13/2019
Last Update Date	:	09/13/2019

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