Provider Demographics
NPI:1093003436
Name:PJCK, LLC
Entity Type:Organization
Organization Name:PJCK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:PRINCESS
Authorized Official - Middle Name:NIOMIE
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:347-499-4521
Mailing Address - Street 1:14023 248TH ST
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-2135
Mailing Address - Country:US
Mailing Address - Phone:347-499-4521
Mailing Address - Fax:718-723-8999
Practice Address - Street 1:14023 248TH ST
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-2135
Practice Address - Country:US
Practice Address - Phone:347-499-4521
Practice Address - Fax:718-723-8999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service