Provider Demographics
NPI:1013598044
Name:JUBILEE VACATION INC
Entity Type:Organization
Organization Name:JUBILEE VACATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BOSHUAI
Authorized Official - Middle Name:
Authorized Official - Last Name:XAIO
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:929-264-0269
Mailing Address - Street 1:373 ROUTE 111 STE 10
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-4759
Mailing Address - Country:US
Mailing Address - Phone:631-406-6067
Mailing Address - Fax:
Practice Address - Street 1:373 ROUTE 111 STE 10
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-4759
Practice Address - Country:US
Practice Address - Phone:631-406-6067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty