MEDICARE: JANISE ASHE 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	252Y00000X	Early Intervention Provider Agency	1859867	NY

General Provider Information

NPI Number	:	1235533589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANISE ASHE MSED

Provider Business Mailing Address
First Line	:	17 VANDALIA AVE
Second Line	:	APT 1F
City	:	BROOKLYN
State	:	NY
Zip	:	11239-1022
Country	:	US
Telephone Number	:	347-406-8077
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 VANDALIA AVE
Second Line	:	APT 1F
City	:	BROOKLYN
State	:	NY
Zip	:	11239-1022
Country	:	US
Telephone Number	:	347-406-8077
Fax Number	:

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

Provider Enumeration Date	:	10/15/2014
Last Update Date	:	10/15/2014

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Directions to “ JANISE ASHE MSED” Practice Location

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