Provider Demographics
NPI:1659624625
Name:JESSICA PURPURA LLC
Entity Type:Organization
Organization Name:JESSICA PURPURA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:PURPURA
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:718-427-0848
Mailing Address - Street 1:2137 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-4722
Mailing Address - Country:US
Mailing Address - Phone:718-427-0848
Mailing Address - Fax:
Practice Address - Street 1:2137 E 1ST ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-4722
Practice Address - Country:US
Practice Address - Phone:718-427-0848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty