Healthcare Provider Details

I. General information

NPI: 1649316290
Provider Name (Legal Business Name): CHRISTIAN ALEXANDER JURAK M.S., P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 PETERS BLVD
BRIGHTWATERS NY
11718-1726
US

IV. Provider business mailing address

541 PETERS BLVD
BRIGHTWATERS NY
11718-1726
US

V. Phone/Fax

Practice location:
  • Phone: 516-859-4514
  • Fax:
Mailing address:
  • Phone: 516-859-4514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number015172
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: