Healthcare Provider Details

I. General information

NPI: 1689889719
Provider Name (Legal Business Name): JENNIFER MARGHELLA PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONWARD HEALTHCARE 350 FIFTH AVENUE SUITE 5115
NEW YORK NY
10118
US

IV. Provider business mailing address

319 IONIA AVE
STATEN ISLAND NY
10312-3553
US

V. Phone/Fax

Practice location:
  • Phone: 866-601-6474
  • Fax:
Mailing address:
  • Phone: 718-317-2145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number003292-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: