MEDICARE: NYC DEPARTMENT OF EDUCATION

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

General Provider Information

NPI Number	:	1578820353
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NYC DEPARTMENT OF EDUCATION

Provider Business Mailing Address
First Line	:	1070 E 104TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-4526
Country	:	US
Telephone Number	:	718-444-4090
Fax Number	:

Provider Business Practice Location Address
First Line	:	1070 E 104TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-4526
Country	:	US
Telephone Number	:	718-444-4090
Fax Number	:

Authorized Official
Title or Position	:	RN/SCHOOL HEALTH NURSE
Name	:	MS. NICOLE MOORE
Credential	:
Telephone Number	:	718-444-4090

Provider Enumeration Date	:	04/18/2012
Last Update Date	:	04/18/2012

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Directions to “NYC DEPARTMENT OF EDUCATION ” Practice Location

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