Provider Demographics
NPI:1104105584
Name:J&D THERAPEUTIC INTERVENTION, INC
Entity type:Organization
Organization Name:J&D THERAPEUTIC INTERVENTION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YULIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:POLISHCHUK
Authorized Official - Suffix:
Authorized Official - Credentials:PTMS
Authorized Official - Phone:718-513-3555
Mailing Address - Street 1:3000 OCEAN PKWY APT 6M
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-8328
Mailing Address - Country:US
Mailing Address - Phone:718-513-3555
Mailing Address - Fax:
Practice Address - Street 1:3000 OCEAN PKWY APT 6M
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8328
Practice Address - Country:US
Practice Address - Phone:718-513-3555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024893252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency