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General NPI Number Information
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NPI Number | 1497278782
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Entity Type | Organization
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Legal Business Name | JEA EARLY INTERVENTION SERVICES
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Dates
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Enumeration Date | 07/19/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 93-46 215 STREET
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City | QUEENS VILLAGE
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State | NY
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Zip | 11428
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Country | US
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Telephone | 917-288-5753
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Fax |
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Provider Business Mailing Address
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Address Line | 9346 215TH ST
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City | QUEENS VILLAGE
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State | NY
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Zip | 11428-1708
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Country | US
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Telephone | 917-288-5753
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Fax |
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Authorized Official
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Title or Position | SPECIAL ED TEACHER
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Name | JOSIANE ANGLADE
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Credential | MD
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Telephone | 917-288-5753
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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 | TF-3534719
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License Number State | NY
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