Provider Demographics
NPI:1861843179
Name:DEPARTMENT OF EDUCATION
Entity type:Organization
Organization Name:DEPARTMENT OF EDUCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DORLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-365-5013
Mailing Address - Street 1:860 GRAND CONCOURSE APT 6L
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-2818
Mailing Address - Country:US
Mailing Address - Phone:917-365-5013
Mailing Address - Fax:
Practice Address - Street 1:860 GRAND CONCOURSE APT 6L
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-2818
Practice Address - Country:US
Practice Address - Phone:917-365-5013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:860 GRAND CONCOURSE APT 6L
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency