Provider Demographics
NPI:1235583113
Name:BOBB, JANELLE J (MASTER'S)
Entity Type:Individual
Prefix:MISS
First Name:JANELLE
Middle Name:J
Last Name:BOBB
Suffix:
Gender:F
Credentials:MASTER'S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 THOMAS S BOYLAND ST
Mailing Address - Street 2:APT 9N
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-4156
Mailing Address - Country:US
Mailing Address - Phone:347-894-1413
Mailing Address - Fax:
Practice Address - Street 1:249 THOMAS S BOYLAND ST
Practice Address - Street 2:APT 9N
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-4156
Practice Address - Country:US
Practice Address - Phone:347-894-1413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2529223174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist