MEDICARE: MS. FAITH JOY WHITE TEACHER

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

General Provider Information

NPI Number	:	1154685337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. FAITH JOY WHITE TEACHER

Provider Business Mailing Address
First Line	:	4068 EDSON AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-2244
Country	:	US
Telephone Number	:	718-994-1883
Fax Number	:

Provider Business Practice Location Address
First Line	:	4068 EDSON AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-2244
Country	:	US
Telephone Number	:	718-994-1883
Fax Number	:

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

Provider Enumeration Date	:	07/02/2012
Last Update Date	:	07/02/2012

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