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General NPI Number Information
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NPI Number | 1780005413
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Entity Type | Organization
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Legal Business Name | JS GERIATRIC PSYCHOLOGICAL SERVICES P.C.
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Dates
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Enumeration Date | 12/24/2013
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Last Update Date | 12/24/2013
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Provider Practice Location Address
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Address Line | 11835 QUEENS BLVD SUITE 1403
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City | FOREST HILLS
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State | NY
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Zip | 11375-7200
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Country | US
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Telephone | 718-268-6600
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Fax | 718-268-6065
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Provider Business Mailing Address
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Address Line | 11835 QUEENS BLVD SUITE 1403
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City | FOREST HILLS
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State | NY
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Zip | 11375-7200
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Country | US
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Telephone | 718-268-6600
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Fax | 718-268-6065
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | MRS. JESSICA SHROEDER
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Credential |
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Telephone | 718-268-6600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2881-057
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License Number State | WI
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