MEDICARE: KIDSPLORATION

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	24451	NY

General Provider Information

NPI Number	:	1750638474
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDSPLORATION

Provider Business Mailing Address
First Line	:	1086 BERGEN AVE APT 3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5377
Country	:	US
Telephone Number	:	718-251-3924
Fax Number	:

Provider Business Practice Location Address
First Line	:	1086 BERGEN AVE APT 3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5377
Country	:	US
Telephone Number	:	718-251-3924
Fax Number	:

Authorized Official
Title or Position	:	TEACHER
Name	:	MS. SHARISSE PEARSON
Credential	:	MS. SP. ED
Telephone Number	:	718-251-3924

Provider Enumeration Date	:	08/13/2012
Last Update Date	:	08/13/2012

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Directions to “KIDSPLORATION ” Practice Location

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