NPIMap

Organization Active NPI

Jack & Jill Developmental Services, SLP, OT & Psychology, PLLP

  • Early Intervention Provider Agency
  • Liberty, NY
National Provider Identifier
1336482223
Registry record updated Mar 29, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Early Intervention Provider AgencyTaxonomy code 252Y00000X
License
008719 Issued in NY
Legal business name
JACK & JILL DEVELOPMENTAL SERVICES, SLP, OT & PSYCHOLOGY, PLLP
Practice address
17 N Main St
Liberty, NY 12754-1807
Phone
(845) 292-4134
Fax
(845) 292-4134
NPI assigned
Mar 29, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2013

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Early Intervention Provider Agency 252Y00000X 008719 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

Locations

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

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1364515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364515200000",
    "number": "1336482223",
    "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 & JILL DEVELOPMENTAL SERVICES, SLP, OT & PSYCHOLOGY, PLLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-29",
        "last_updated": "2013-03-29",
        "status": "A",
        "authorized_official_last_name": "JENSEN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "PETER",
        "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": "008719",
            "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 Mar 29, 2013; 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.