Organization
JELLYBEAN EI INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HARRY AZCONA (PRESIDENT)
(718) 219-8484
Entity
Organization
Contact information
Practice address
13524 96TH ST, OZONE PARK, NY 11417
(347) 784-7984
Mailing address
13524 96TH ST, OZONE PARK, NY 11417-2820
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
NY
252Y00000X
Early Intervention Provider Agency
Primary
—
NY
Other
Enumeration date
06/06/2018
Last updated
11/01/2024
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