Healthcare Provider Details

I. General information

NPI: 1962814467
Provider Name (Legal Business Name): JOEL JEZEQUEL DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 UNION SQ W 3RD FLOOR
NEW YORK NY
10003-3217
US

IV. Provider business mailing address

211 S NARCISSUS AVE MU-1
WEST PALM BEACH FL
33401
US

V. Phone/Fax

Practice location:
  • Phone: 212-750-1110
  • Fax:
Mailing address:
  • Phone: 561-790-8256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number037950
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: