Healthcare Provider Details

I. General information

NPI: 1770954554
Provider Name (Legal Business Name): JURUKAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2015
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14815 ARCHER AVE
JAMAICA NY
11435-4316
US

IV. Provider business mailing address

8628 110TH ST
RICHMOND HILL NY
11418-1629
US

V. Phone/Fax

Practice location:
  • Phone: 347-995-2745
  • Fax:
Mailing address:
  • Phone: 347-995-2745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RUBEN CRUZ
Title or Position: PRESIDENT
Credential:
Phone: 347-995-2745