MEDICARE: MRS. NANCY JUKIC MS.ED.

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	251C00000X	Developmentally Disabled Services Day Training Agency	101Y00000X	NY

General Provider Information

NPI Number	:	1487895173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NANCY JUKIC MS.ED.

Provider Business Mailing Address
First Line	:	2808 141ST ST
Second Line	:	APT. 3A
City	:	FLUSHING
State	:	NY
Zip	:	11354-1671
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3060 E TREMONT AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-5726
Country	:	US
Telephone Number	:	718-239-1790
Fax Number	:

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

Provider Enumeration Date	:	03/10/2009
Last Update Date	:	03/10/2009

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