Provider Demographics
NPI:1649517863
Name:JASSAL, VENUS (MSED)
Entity type:Individual
Prefix:MRS
First Name:VENUS
Middle Name:
Last Name:JASSAL
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21768 STEWART RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-3539
Mailing Address - Country:US
Mailing Address - Phone:917-690-9575
Mailing Address - Fax:
Practice Address - Street 1:21768 STEWART RD
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-3539
Practice Address - Country:US
Practice Address - Phone:917-690-9575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency