Healthcare Provider Details

I. General information

NPI: 1629902291
Provider Name (Legal Business Name): JADA TOOTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 VAN CORTLANDT AVE W APT 2N
BRONX NY
10463-2709
US

IV. Provider business mailing address

140 VAN CORTLANDT AVE W APT 2N
BRONX NY
10463-2709
US

V. Phone/Fax

Practice location:
  • Phone: 201-916-7115
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number2051103261
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: