Provider Demographics
NPI:1073934360
Name:JAD-EIT CONSULTING LLC
Entity Type:Organization
Organization Name:JAD-EIT CONSULTING LLC
Other - Org Name:JAD-EIT CONSULTING LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPECIAL EDUCATION INSTRUCTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:IVY
Authorized Official - Middle Name:JOANNE
Authorized Official - Last Name:CHANGLEE
Authorized Official - Suffix:
Authorized Official - Credentials:MS SPECIAL EDUCATION
Authorized Official - Phone:347-413-9846
Mailing Address - Street 1:125 HAWTHORNE ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-5857
Mailing Address - Country:US
Mailing Address - Phone:718-940-9408
Mailing Address - Fax:
Practice Address - Street 1:125 HAWTHORNE ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-5857
Practice Address - Country:US
Practice Address - Phone:718-940-9408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-03
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY17Medicaid