Provider Demographics
NPI:1598027724
Name:JEAN-JACQUES, JORDAN (MS ED)
Entity Type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:
Last Name:JEAN-JACQUES
Suffix:
Gender:M
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 E 18TH ST APT D4
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-4705
Mailing Address - Country:US
Mailing Address - Phone:917-882-0610
Mailing Address - Fax:
Practice Address - Street 1:229 E 18TH ST APT D4
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-4705
Practice Address - Country:US
Practice Address - Phone:917-882-0610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency