Healthcare Provider Details

I. General information

NPI: 1093955429
Provider Name (Legal Business Name): JBFCS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2009
Last Update Date: 02/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 E 96TH ST
NEW YORK NY
10128-3805
US

IV. Provider business mailing address

336 E 96TH ST
NEW YORK NY
10128-3805
US

V. Phone/Fax

Practice location:
  • Phone: 212-828-8500
  • Fax: 212-828-8600
Mailing address:
  • Phone: 212-828-8500
  • Fax: 212-828-8600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY CLARKE
Title or Position: AMI DIRECTOR
Credential: LMSW
Phone: 212-828-8500