Provider Demographics
NPI:1023437548
Name:JORDAN CAMERON MOSES PLAYHOUSE FOR SPEECH AND LANGUAGE, P.C.
Entity type:Organization
Organization Name:JORDAN CAMERON MOSES PLAYHOUSE FOR SPEECH AND LANGUAGE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:VANESSA
Authorized Official - Last Name:RAMPERSAD
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:516-581-2098
Mailing Address - Street 1:118 OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-1130
Mailing Address - Country:US
Mailing Address - Phone:516-581-2098
Mailing Address - Fax:
Practice Address - Street 1:118 OHIO AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-1130
Practice Address - Country:US
Practice Address - Phone:516-581-2098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-11
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013020-1251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY235Z00000XOtherSPEECH-LANGUAGE PATHOLOGY