Individual
JASON FORDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
91-14 MERRICK BLVD, QUEENS, NY 11432
(718) 262-8190
Mailing address
9114 MERRICK BLVD, JAMAICA, NY 11432-5247
(718) 262-8190
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
01/25/2018
Last updated
01/25/2018
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