MEDICARE: MS. INGER CHARLENE BEATTY TEACHER

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	171W00000X	Contractor

General Provider Information

NPI Number	:	1811356660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. INGER CHARLENE BEATTY TEACHER

Provider Business Mailing Address
First Line	:	1708 PARK PL
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11233-4508
Country	:	US
Telephone Number	:	347-512-2595
Fax Number	:	718-483-8880

Provider Business Practice Location Address
First Line	:	1708 PARK PL
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11233-4508
Country	:	US
Telephone Number	:	347-512-2595
Fax Number	:	718-483-8880

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

Provider Enumeration Date	:	02/22/2016
Last Update Date	:	02/22/2016

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