MEDICARE: MISS CHARLAYNE WILLIAMS MSED

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	174400000X	Specialist		NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	252Y00000X	OTHER	NY	EARLY INTERVENTION

General Provider Information

NPI Number	:	1134484587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CHARLAYNE WILLIAMS MSED

Provider Business Mailing Address
First Line	:	PO BOX 340041
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-0041
Country	:	US
Telephone Number	:	718-253-1517
Fax Number	:

Provider Business Practice Location Address
First Line	:	1618 E 53RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-3917
Country	:	US
Telephone Number	:	347-749-0374
Fax Number	:

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

Provider Enumeration Date	:	07/11/2012
Last Update Date	:	07/11/2012

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Directions to “ MISS CHARLAYNE WILLIAMS MSED” Practice Location

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