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General NPI Number Information
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NPI Number | 1457725905
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Entity Type | Organization
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Legal Business Name | AAVJN&AIJA CORNER
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Dates
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Enumeration Date | 11/20/2015
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Last Update Date | 11/20/2015
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Provider Practice Location Address
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Address Line | 13010 144TH ST
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City | JAMAICA
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State | NY
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Zip | 11436-2214
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Country | US
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Telephone | 718-781-5417
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Fax | 718-322-7480
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Provider Business Mailing Address
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Address Line | 13010 144TH ST
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City | JAMAICA
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State | NY
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Zip | 11436-2214
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Country | US
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Telephone | 718-781-5417
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Fax | 718-322-7480
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Authorized Official
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Title or Position | CEO/ OWNER
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Name | MS. DEBRA ANN BACCHUS
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Credential |
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Telephone | 718-781-5417
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225500000X
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Taxonomy Name | Respiratory/Developmental/Rehabilitative Specialist/Technologist
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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