MEDICARE: MISS EDITH SAINT JEAN

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	251J00000X	Nursing Care Agency	264720-1	NY

General Provider Information

NPI Number	:	1205229770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS EDITH SAINT JEAN

Provider Business Mailing Address
First Line	:	47 4 BROOKLYN AVE. # 1H
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225
Country	:	US
Telephone Number	:	646-338-0839
Fax Number	:

Provider Business Practice Location Address
First Line	:	474 BROOKLYN AVE APT 1H
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-4418
Country	:	US
Telephone Number	:	646-338-0839
Fax Number	:

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

Provider Enumeration Date	:	03/09/2015
Last Update Date	:	03/09/2015

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