Provider Demographics
NPI:1588103048
Name:JEAN BAPTISTE, JERRICE (MS SPECIAL ED)
Entity type:Individual
Prefix:
First Name:JERRICE
Middle Name:
Last Name:JEAN BAPTISTE
Suffix:
Gender:F
Credentials:MS SPECIAL ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:577 POPPLETOWN RD
Mailing Address - Street 2:
Mailing Address - City:ULSTER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12487-5426
Mailing Address - Country:US
Mailing Address - Phone:917-442-5996
Mailing Address - Fax:
Practice Address - Street 1:577 POPPLETOWN RD
Practice Address - Street 2:
Practice Address - City:ULSTER PARK
Practice Address - State:NY
Practice Address - Zip Code:12487-5426
Practice Address - Country:US
Practice Address - Phone:917-442-5996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY679454174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY679454OtherPERMANENT SPECIAL EDUCATION TEACHER