Individual
MR. MICHAEL DE JESUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSED.
Contact information
Practice address
3011 LAFAYETTE AVE, BRONX, NY 10465-2309
(347) 851-2719
Mailing address
3011 LAFAYETTE AVE, BRONX, NY 10465-2309
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
06/10/2019
Last updated
06/10/2019
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