MEDICARE: MRS. IONA HYACINTH WATSON MS. 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

General Provider Information

NPI Number	:	1609130236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. IONA HYACINTH WATSON MS. ED

Provider Business Mailing Address
First Line	:	1075 E 85TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-4229
Country	:	US
Telephone Number	:	718-209-9777
Fax Number	:	347-554-8855

Provider Business Practice Location Address
First Line	:	1075 E 85TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-4229
Country	:	US
Telephone Number	:	718-209-9777
Fax Number	:	347-554-8855

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

Provider Enumeration Date	:	06/28/2012
Last Update Date	:	06/28/2012

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