Healthcare Provider Details

I. General information

NPI: 1366102048
Provider Name (Legal Business Name): JM EXPLORE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2021
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15315 75TH AVE APT 3B
FLUSHING NY
11367-3013
US

IV. Provider business mailing address

15315 75TH AVE APT 3B
FLUSHING NY
11367-3013
US

V. Phone/Fax

Practice location:
  • Phone: 646-436-2506
  • Fax:
Mailing address:
  • Phone: 646-436-2506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JANERA MUSA
Title or Position: PRESIDENT
Credential: MS CCC-SLP
Phone: 646-436-2506