Organization
LJ INDEPENDENT SERVICES INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LORETTA FRANCES JACKSON MSED (PRESIDENT)
(917) 594-7948
Entity
Organization
Contact information
Practice address
40 MEMORIAL HWY APT 14H, NEW ROCHELLE, NY 10801-8326
(917) 504-7948
Mailing address
40 MEMORIAL HWY APT 14H, NEW ROCHELLE, NY 10801-8326
(917) 504-7948
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
109522413
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1518229707
—
NY
Enumeration date
10/03/2017
Last updated
10/03/2017
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