Basic Information
| Provider Information | |||||||||
| NPI: | 1376952606 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAHAN | ||||||||
| FirstName: | ISHRAT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5101 39TH AVE | ||||||||
| Address2: | R63 | ||||||||
| City: | SUNNYSIDE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 111041172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3475138757 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10470 QUEENS BLVD | ||||||||
| Address2: | BLEULER PSYCHOTHERAY CENTER, SUITE 200 | ||||||||
| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113753638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182756010 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2014 | ||||||||
| LastUpdateDate: | 08/13/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.