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General NPI Number Information
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NPI Number | 1427590991
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Entity Type | Organization
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Legal Business Name | JESS'S KIDS, INC.
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Dates
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Enumeration Date | 11/15/2016
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Last Update Date | 11/15/2016
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Provider Practice Location Address
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Address Line | 3063 BROWER AVE
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City | OCEANSIDE
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State | NY
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Zip | 11572-4411
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Country | US
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Telephone | 516-608-9851
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Fax | 516-608-9851
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Provider Business Mailing Address
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Address Line | 3063 BROWER AVE
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City | OCEANSIDE
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State | NY
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Zip | 11572-4411
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Country | US
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Telephone | 516-608-9851
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Fax | 516-608-9851
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. JESSICA DAWN OMEARA
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Credential | MSED
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Telephone | 516-662-6141
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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 | NY
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