| Doctor Name: | JAN HURLEY |
| NPI Number: | 1063534626 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 053409 |
| Business Practice Address: | 9745 Queens Blvd Rego Park, NY - 113742101 |
| Business Phone Number: | 7188962500 |
| Business Fax Number: | 7182752094 |
| Mailing Address: | 57 Saint Marks Pl, NEW YORK |
| State: | NY |
| Postal Code: | 100037902 |
| Phone Number: | 2129823470 |
| Fax Number: | 2124770521 |
| NPI Enumeration Date: | 04/04/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 053409 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |