Provider Demographics
NPI:1871933556
Name:SALMRE-JOKS, TIINA LY
Entity type:Individual
Prefix:MRS
First Name:TIINA
Middle Name:LY
Last Name:SALMRE-JOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SHORE RD
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-2751
Mailing Address - Country:US
Mailing Address - Phone:516-883-1724
Mailing Address - Fax:
Practice Address - Street 1:21 SHORE RD
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-2751
Practice Address - Country:US
Practice Address - Phone:516-883-1724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY132560021252Y00000X
NY989878001252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency