Healthcare Provider Details

I. General information

NPI: 1821447996
Provider Name (Legal Business Name): JESSICA HUFNAGEL DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 12/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 HEALTHY WAY
ELLENVILLE NY
12428-5612
US

IV. Provider business mailing address

10 HEALTHY WAY
ELLENVILLE NY
12428-5612
US

V. Phone/Fax

Practice location:
  • Phone: 845-210-3035
  • Fax: 845-210-3039
Mailing address:
  • Phone: 845-210-3035
  • Fax: 845-210-3039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number038894-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: