Healthcare Provider Details

I. General information

NPI: 1427693431
Provider Name (Legal Business Name): JARED EINHORN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2019
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 NORTHWEST DR
FARMINGDALE NY
11735-4935
US

IV. Provider business mailing address

475 NORTHERN BLVD STE 27
GREAT NECK NY
11021-4802
US

V. Phone/Fax

Practice location:
  • Phone: 516-420-2900
  • Fax: 516-420-2908
Mailing address:
  • Phone: 516-344-0023
  • Fax: 516-466-7723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number045128
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: