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General NPI Number Information
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NPI Number | 1235640657
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Entity Type | Organization
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Legal Business Name | J.A.G. INTERVENTION SERVICES INC.
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Dates
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Enumeration Date | 10/12/2017
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Last Update Date | 10/12/2017
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Provider Practice Location Address
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Address Line | 13830 COOLIDGE AVE
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City | BRIARWOOD
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State | NY
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Zip | 11435-1117
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Country | US
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Telephone | 718-208-3900
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Fax |
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Provider Business Mailing Address
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Address Line | 13830 COOLIDGE AVE
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City | BRIARWOOD
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State | NY
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Zip | 11435-1117
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Country | US
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Telephone | 718-208-3900
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Fax |
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Authorized Official
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Title or Position | TEACHER
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Name | JESSY ROMANO
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Credential | MSED
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Telephone | 718-208-3900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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