Provider Demographics
NPI:1780005413
Name:JS GERIATRIC PSYCHOLOGICAL SERVICES P.C.
Entity Type:Organization
Organization Name:JS GERIATRIC PSYCHOLOGICAL SERVICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHROEDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-268-6600
Mailing Address - Street 1:11835 QUEENS BLVD
Mailing Address - Street 2:SUITE 1403
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-7200
Mailing Address - Country:US
Mailing Address - Phone:718-268-6600
Mailing Address - Fax:718-268-6065
Practice Address - Street 1:11835 QUEENS BLVD
Practice Address - Street 2:SUITE 1403
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7200
Practice Address - Country:US
Practice Address - Phone:718-268-6600
Practice Address - Fax:718-268-6065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-24
Last Update Date:2013-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2881-057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty