Healthcare Provider Details

I. General information

NPI: 1134997638
Provider Name (Legal Business Name): JAZMIN M STEPCHUK DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2023
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 E 88TH ST LOWR LEVEL
NEW YORK NY
10128-1151
US

IV. Provider business mailing address

815 2ND AVE RM 701
NEW YORK NY
10017-4500
US

V. Phone/Fax

Practice location:
  • Phone: 212-499-0848
  • Fax:
Mailing address:
  • Phone: 212-499-0848
  • Fax: 212-953-1353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number051056
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: