MEDICARE: CHILDREN R TREASURES

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	17	OTHER	NY	SPECIAL INSTRUCTION

General Provider Information

NPI Number	:	1891058475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDREN R TREASURES

Provider Business Mailing Address
First Line	:	773 PINE ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-5025
Country	:	US
Telephone Number	:	718-257-1283
Fax Number	:

Provider Business Practice Location Address
First Line	:	773 PINE ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-5025
Country	:	US
Telephone Number	:	718-257-1283
Fax Number	:

Authorized Official
Title or Position	:	SPECIAL INSTRUCTOR
Name	:	MISS DARIA C JACKSON
Credential	:	MS SPED
Telephone Number	:	718-257-1283

Provider Enumeration Date	:	06/19/2012
Last Update Date	:	06/19/2012

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Directions to “CHILDREN R TREASURES ” Practice Location

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