Organization
AAVJN&AIJA CORNER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEBRA ANN BACCHUS (CEO/ OWNER)
(718) 781-5417
Entity
Organization
Contact information
Practice address
13010 144TH ST, JAMAICA, NY 11436-2214
(718) 781-5417
(718) 322-7480
Mailing address
13010 144TH ST, JAMAICA, NY 11436-2214
(718) 781-5417
(718) 322-7480
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
225500000X
Respiratory/Developmental/Rehabilitative Specialist/Technologist
—
—
252Y00000X
Early Intervention Provider Agency
—
—
Other
Enumeration date
11/20/2015
Last updated
11/20/2015
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