=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669836458
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JMD LEARNING SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2016
-----------------------------------------------------
Last Update Date | 04/08/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 POST AVE SUITE 203
-----------------------------------------------------
City | WESTBURY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11590-2289
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-501-9500
-----------------------------------------------------
Fax | 516-501-9501
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 POST AVE SUITE 203
-----------------------------------------------------
City | WESTBURY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11590-2289
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-501-9500
-----------------------------------------------------
Fax | 516-501-9501
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. REENA SHARMA
-----------------------------------------------------
Credential | CSA
-----------------------------------------------------
Telephone | 516-501-9500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------