NPIMap

Organization Active NPI

Jack and Jill Developmental Services

  • Early Intervention Provider Agency
  • Liberty, NY
National Provider Identifier
1265780431
Registry record updated Aug 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Early Intervention Provider AgencyTaxonomy code 252Y00000X
License
8719 Issued in NY
Legal business name
JACK AND JILL DEVELOPMENTAL SERVICES
Practice address
17 N Main St
Liberty, NY 12754-1807
Phone
(845) 292-4134
Fax
(845) 292-4134
NPI assigned
Aug 20, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jeffrey P Jensen, PH.D
Title
Partner
Phone
(845) 292-4134

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Early Intervention Provider Agency 252Y00000X 8719 NY Primary

Addresses

Primary practice location

17 N Main St
Liberty, NY 12754-1807

Mailing address

17 N Main St
Liberty, NY 12754-1807
Phone (845) 292-4134

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1345420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1345420800000",
    "number": "1265780431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 N MAIN ST",
            "city": "LIBERTY",
            "state": "NY",
            "postal_code": "127541807",
            "telephone_number": "845-292-4134",
            "fax_number": "845-292-4134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 N MAIN ST",
            "city": "LIBERTY",
            "state": "NY",
            "postal_code": "127541807",
            "telephone_number": "845-292-4134",
            "fax_number": "845-292-4134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK AND JILL DEVELOPMENTAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-20",
        "last_updated": "2012-08-20",
        "status": "A",
        "authorized_official_last_name": "JENSEN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "845-292-4134",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "NY",
            "license": "8719",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Liberty, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.