Healthcare Provider Details

I. General information

NPI: 1023182862
Provider Name (Legal Business Name): JACKIE ZAFFARESE M.S.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACKIE JEROLIMA M.S.P.T.

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 US HIGHWAY 130
EAST WINDSOR NJ
08520-2792
US

IV. Provider business mailing address

3 OAKMONT CT
EAST WINDSOR NJ
08520-2509
US

V. Phone/Fax

Practice location:
  • Phone: 609-918-0600
  • Fax: 609-918-0601
Mailing address:
  • Phone: 609-947-0542
  • Fax: 609-918-0601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: