Healthcare Provider Details

I. General information

NPI: 1861967739
Provider Name (Legal Business Name): NJOYTEACH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2018
Last Update Date: 10/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18616 80TH DR
JAMAICA NY
11432-5805
US

IV. Provider business mailing address

18616 80TH DR
JAMAICA NY
11432-5805
US

V. Phone/Fax

Practice location:
  • Phone: 917-515-0149
  • Fax:
Mailing address:
  • Phone: 917-515-0149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MR. NERIK SHAMALOV
Title or Position: M.D. SPED/TEACHER
Credential: M.D
Phone: 917-515-0149