=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548608250
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JILL ROTLEVI INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2013
-----------------------------------------------------
Last Update Date | 08/01/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 526 CHERRY LANE
-----------------------------------------------------
City | NY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-555-1212
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 BROADWAY
-----------------------------------------------------
City | NY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11111-3509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JILL ROTLEVI
-----------------------------------------------------
Credential | MS. SP.ED.
-----------------------------------------------------
Telephone | 718-309-2972
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number | 1149664
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------