MEDICARE: JY ADULT SOCIAL DAY CARE SERVICE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1093684516
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JY ADULT SOCIAL DAY CARE SERVICE, INC.

Provider Business Mailing Address
First Line	:	6602 11TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-5901
Country	:	US
Telephone Number	:	917-338-1183
Fax Number	:	718-618-9219

Provider Business Practice Location Address
First Line	:	6602 11TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-5901
Country	:	US
Telephone Number	:	917-338-1183
Fax Number	:	718-618-9219

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NISAN BABAEW
Credential	:
Telephone Number	:	718-238-3636

Provider Enumeration Date	:	11/03/2025
Last Update Date	:	11/03/2025

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