Provider Demographics
NPI:1639913882
Name:FORBES, JERMAINE R (CHHA)
Entity type:Individual
Prefix:
First Name:JERMAINE
Middle Name:R
Last Name:FORBES
Suffix:
Gender:M
Credentials:CHHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 BABYLON ST
Mailing Address - Street 2:
Mailing Address - City:ISLIP TERRACE
Mailing Address - State:NY
Mailing Address - Zip Code:11752-1002
Mailing Address - Country:US
Mailing Address - Phone:631-431-5353
Mailing Address - Fax:408-689-6310
Practice Address - Street 1:20 BABYLON ST
Practice Address - Street 2:
Practice Address - City:ISLIP TERRACE
Practice Address - State:NY
Practice Address - Zip Code:11752-1002
Practice Address - Country:US
Practice Address - Phone:631-431-5353
Practice Address - Fax:408-689-6310
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-22
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY374U00000X
NY00534101374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide