MEDICARE: AJ INNOVATIVE SOLUTIONS

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

General Provider Information

NPI Number	:	1477077865
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AJ INNOVATIVE SOLUTIONS

Provider Business Mailing Address
First Line	:	8075 208TH ST
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11427-1006
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8075 208TH ST
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11427-1006
Country	:	US
Telephone Number	:	718-753-2309
Fax Number	:

Authorized Official
Title or Position	:	SPECIAL EDUCATION TEACHER
Name	:	ANTONIO JHA
Credential	:	SPECIAL INSTRUCTOR
Telephone Number	:	718-753-2309

Provider Enumeration Date	:	07/28/2017
Last Update Date	:	07/28/2017

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Directions to “AJ INNOVATIVE SOLUTIONS ” Practice Location

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