Provider Demographics
NPI:1306678560
Name:JAY SHREE KRISHNA DDD CENTER LLC
Entity type:Organization
Organization Name:JAY SHREE KRISHNA DDD CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PARUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-978-5555
Mailing Address - Street 1:101 INDUSTRIAL AVE STE C
Mailing Address - Street 2:
Mailing Address - City:LITTLE FERRY
Mailing Address - State:NJ
Mailing Address - Zip Code:07643-1936
Mailing Address - Country:US
Mailing Address - Phone:201-870-6265
Mailing Address - Fax:
Practice Address - Street 1:101 INDUSTRIAL AVE STE C
Practice Address - Street 2:
Practice Address - City:LITTLE FERRY
Practice Address - State:NJ
Practice Address - Zip Code:07643-1936
Practice Address - Country:US
Practice Address - Phone:201-870-6265
Practice Address - Fax:201-870-6263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities