Provider Demographics
NPI:1003521113
Name:M&J SELENE CORP.
Entity Type:Organization
Organization Name:M&J SELENE CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL EDUCATION / ABA THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JATAON
Authorized Official - Middle Name:SELENE
Authorized Official - Last Name:WHITLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:347-278-3747
Mailing Address - Street 1:3835 SEDGWICK AVE APT 4A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4454
Mailing Address - Country:US
Mailing Address - Phone:347-278-3747
Mailing Address - Fax:
Practice Address - Street 1:3835 SEDGWICK AVE APT 4A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-4454
Practice Address - Country:US
Practice Address - Phone:347-278-3747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services