Provider Demographics
NPI:1760015671
Name:JVJ EARLY INTERVENTION CORP
Entity Type:Organization
Organization Name:JVJ EARLY INTERVENTION CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:WYKA
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:516-404-1690
Mailing Address - Street 1:176 LITTLE NECK RD
Mailing Address - Street 2:
Mailing Address - City:CENTERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11721-1144
Mailing Address - Country:US
Mailing Address - Phone:516-404-1690
Mailing Address - Fax:
Practice Address - Street 1:176 LITTLE NECK RD
Practice Address - Street 2:
Practice Address - City:CENTERPORT
Practice Address - State:NY
Practice Address - Zip Code:11721-1144
Practice Address - Country:US
Practice Address - Phone:516-404-1690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency