MEDICARE: EDWINA ROGERS M.S.ED

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	734935131	NY

General Provider Information

NPI Number	:	1346651155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWINA ROGERS M.S.ED

Provider Business Mailing Address
First Line	:	150 GRANITE AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10303-2718
Country	:	US
Telephone Number	:	718-816-1422
Fax Number	:	718-816-1428

Provider Business Practice Location Address
First Line	:	1311 55TH STREET
Second Line	:
City	:	STATEN ISLAND
State	:	NEW YORK
Zip	:	11219
Country	:	UM
Telephone Number	:	718-851-6100
Fax Number	:

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

Provider Enumeration Date	:	05/14/2014
Last Update Date	:	05/15/2014

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