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NPI Code Detail

MEDICARE: DR. JACKIE CODY ED.D.; MS. ED.; ADV

MEDICARE: DR. JACKIE CODY ED.D.; MS. ED.; ADV
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
1101Y00000XCounselor2517NY

General Provider Information

NPI Number : 1790192854
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACKIE CODY ED.D.; MS. ED.; ADV
Provider Business Mailing Address
First Line : 1692 E 45TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11234-3622
Country : US
Telephone Number : 718-758-1090
Fax Number :
Provider Business Practice Location Address
First Line : 1692 E 45TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11234-3622
Country : US
Telephone Number : 718-758-1090
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2014
Last Update Date : 07/21/2014

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