MEDICARE: LEAGUE SCHOOL

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	251300000X	Local Education Agency (LEA)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770771685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEAGUE SCHOOL

Provider Business Mailing Address
First Line	:	483 CLERMONT AVE
Second Line	:	3RD FL
City	:	BROOKLYN
State	:	NY
Zip	:	11238-2253
Country	:	US
Telephone Number	:	718-643-5300
Fax Number	:	718-237-2793

Provider Business Practice Location Address
First Line	:	470 VANDERBILT AVE
Second Line	:	3RD FL
City	:	BROOKLYN
State	:	NY
Zip	:	11238-2212
Country	:	US
Telephone Number	:	718-643-5300
Fax Number	:	718-237-2793

Authorized Official
Title or Position	:	COMPTROLLER
Name	:	MR. LEON FISHMAN
Credential	:
Telephone Number	:	718-643-5300

Provider Enumeration Date	:	10/05/2007
Last Update Date	:	02/29/2016

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Directions to “LEAGUE SCHOOL ” Practice Location

Language	Start Address	Practice Location

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