Provider Demographics
NPI:1568723443
Name:JODI FOSSNER LLC
Entity Type:Organization
Organization Name:JODI FOSSNER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL EDUCATION INSTRUCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSSNER
Authorized Official - Suffix:
Authorized Official - Credentials:MASTERS EDUCATION
Authorized Official - Phone:917-459-7122
Mailing Address - Street 1:16 HARDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TAPPAN
Mailing Address - State:NY
Mailing Address - Zip Code:10983-1109
Mailing Address - Country:US
Mailing Address - Phone:917-459-7122
Mailing Address - Fax:845-365-1825
Practice Address - Street 1:16 HARDWOOD DR
Practice Address - Street 2:
Practice Address - City:TAPPAN
Practice Address - State:NY
Practice Address - Zip Code:10983-1109
Practice Address - Country:US
Practice Address - Phone:917-459-7122
Practice Address - Fax:845-365-2508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty