MEDICARE: MS. TKEYAH GEORGE

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1629541925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TKEYAH GEORGE

Provider Business Mailing Address
First Line	:	5018 CHURCH AVEUNE
Second Line	:	APT1
City	:	BROOKLYN
State	:	NY
Zip	:	11203
Country	:	US
Telephone Number	:	347-608-8781
Fax Number	:

Provider Business Practice Location Address
First Line	:	283 W 118TH ST APT 5A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10026-1632
Country	:	US
Telephone Number	:	929-499-5390
Fax Number	:

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

Provider Enumeration Date	:	01/09/2019
Last Update Date	:	01/09/2019

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